Zoll Auto-Pulse

Correct me if I am mistaken, but I believe current AHA guidelines recommend against the autopulse.
 
BandageBrigade said:
Correct me if I am mistaken, but I believe current AHA guidelines recommend against the autopulse.
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I don't think they recommend specifically AGAINST mechanical CPR devices (Zoll and Physio give them WAY too much money for that) but I don't think they got the class I A recommendation (and moving manual CPR down the recommendation list) they were looking for.
 
Our service now doesn't have them, but the company I worked at before did. I greatly appreciate the autopulse. The company that I worked for that uses them has one of the highest resuscitation rates in the US. Not saying that thats directly due to the autopulse, but I'm fond of it myself.
 
Was not impressed with the autopulse when they came thru for us to test. Numerous internal injuries post use. I'll save the details... someone hit on it earlier.
Now the Lucas was nice, and did quite well.. especially for those times when we move to the unit ( hallways, stairs, etc ). We don't stick around long on scene... 1 round of ACLS, and we move to the medic unit.
 
MasterIntubator said:
Was not impressed with the autopulse when they came thru for us to test. Numerous internal injuries post use. I'll save the details... someone hit on it earlier.
Now the Lucas was nice, and did quite well.. especially for those times when we move to the unit ( hallways, stairs, etc ). We don't stick around long on scene... 1 round of ACLS, and we move to the medic unit.
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I'm not sure if you consider chest compressions and shocking ACLS or not but IMHO it's a mistake to move the patient unless you've achieved ROSC or completed at least four or five 2-minute cycles. What's the rush?
 
No rush, we actually run a very smooth, relaxed code. But we don't stick around. And our statistics on ROSC are very high, and there is little to no compression loss, or loss in quality when moving, running a couple codes a month.... I say it works quite well for us, and there was no difference in the stay-n-play group vs our load-n-go crews.... unless there were some abnormal obstacles we had to overcome ( bariatric, access issues... )
 
ROSC rates may be high, but what are your survival to discharge rates? That's the only statistic that really matters.
 
Ahhh... I think I see what you are saying... 1 round of ACLS for us is going thru the algorythm 1x. ( CPR - shock PRN, 1st line drugs, airway... ) The second round of drugs would be considered "round 2". Even then, we give a few minutes to allow the drugs to take effect before loading them again.
 
Well, we have 5-6 discharges in the past couple years that we know of, 2 of which we regularly keep contact with and visit.... all with no neurological deficits, and 20-30 minute down times. One we shocked 7 times. That is just our house.... the other houses in our area have similar rates.
 
Glad it works for y'all, it's certainly not the norm. Transporting arrest is usually more trouble than it's worth, and leads to worse outcomes.
 
Thats what they told us years ago, but we having proven that it has been successful.. and management took notice. Kinda like the Res-Q-Pod kick in 2006 or so... they just did not give us any edge.... so they lost their place in our standards.
 
In our area it's a matter of resorces. We don't have an engine full of helpfull fireman showing up on our calls and we don't always have another unit available. We do our best to maintain good care on the move and have a few ROSC and one or two survive to discharge Pt's a year. (we only run around 1200 calls a year.) We just don't have enough people to stay and play the only help we have is in the ED so we go to them and get the unit free for another call.
 
TxParamedic said:
In our area it's a matter of resorces. We don't have an engine full of helpfull fireman showing up on our calls and we don't always have another unit available. We do our best to maintain good care on the move and have a few ROSC and one or two survive to discharge Pt's a year. (we only run around 1200 calls a year.) We just don't have enough people to stay and play the only help we have is in the ED so we go to them and get the unit free for another call.
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Sounds like the service I worked for when I was in TX. We wound up running moving codes all the time :S No autopulse or anything like that though. Just the duty unit, on call truck, and possibly the chief in his fly-truck. The FD for our town was all vollie, and only one of them was an EMT, although he worked for us on the paid EMS side.
 
TxParamedic, although we run more than 1200 calls a year, we too often end up running just by ourselves. We end using bystanders and family members at times ("allow family members to be present for the resuscitation" the AHA says. We take it a step further due to necessity...). I've found not transporting non-ROSC patients has drastically reduced the need for manpower on cardiac arrest. Once the paramedic level stuff is done (which in our system consist of placing an IO, we use King airways as first line on cardiac arrest which means a Basic can place it) we are free to swap back and forth performing CPR. If ROSC is achieved, we move the patient like any other critical. If not, at the end of 20 minutes we call the code in place. No need for multiple people to continue CPR (of suspect quality) while moving, no need to try to do "one handed" CPR while transporting, no need to "cot surf". In general, it's fairly easy, if a little tiring, to run a code for 20 minutes with two people.
 
usalsfyre said:
TxParamedic, although we run more than 1200 calls a year, we too often end up running just by ourselves. We end using bystanders and family members at times ("allow family members to be present for the resuscitation" the AHA says. We take it a step further due to necessity...). I've found not transporting non-ROSC patients has drastically reduced the need for manpower on cardiac arrest. Once the paramedic level stuff is done (which in our system consist of placing an IO, we use King airways as first line on cardiac arrest which means a Basic can place it) we are free to swap back and forth performing CPR. If ROSC is achieved, we move the patient like any other critical. If not, at the end of 20 minutes we call the code in place. No need for multiple people to continue CPR (of suspect quality) while moving, no need to try to do "one handed" CPR while transporting, no need to "cot surf". In general, it's fairly easy, if a little tiring, to run a code for 20 minutes with two people.
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This^ is how it should be. We have an HD cardiac arrest protocol now. It is based off a 2 person basic/medic crew. Over a 24 minute period broken down into 2 minute blocks both crew members have assigned tasks to complete and swap doing CPR so one person isn't on it for too long. The more responders added to the mix and it begins to slow down the code and complicate things. At the 26 minute mark we are either calling to pronounce or getting ready to load for transport.
 
One issue in small town America is educating the public and administration to the point where they are comfortable dealing with the question "How come they didn't even take grandma to the hospital?" I have brought up the issue to our medical director and nobody wants to touch it with a ten foot pole.
 
TxParamedic said:
One issue in small town America is educating the public and administration to the point where they are comfortable dealing with the question "How come they didn't even take grandma to the hospital?" I have brought up the issue to our medical director and nobody wants to touch it with a ten foot pole.
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I understand the concern, but in my service areas town of 10,000 and surrounding rural county, I, nor any of my coworkers, have run into an issue. If questioned, we simply explain gently that the patient has not responded to our efforts and there's nothing else that can be done. Obviously if there's a safety concern, we transport, but I can't say this has ever crossed my mind. The reaction is typically the same as if resuscitation was never started.

Where I've run into the most resistance is from PROVIDERS who are new to our system. Many of them are extremely uncomfortable with taking that level of responsibility. They are often comforted at the thought of the ED taking ultimate blame.

As far as administrators and med control physicians...the AHA's stance is pretty clear. If your following the 2010 guidelines, your terminating efforts in the field. If your not, and saying your following 2010 guidelines, very frankly, your service is lying.
 
For the at least the last few years we've had a termination of efforts of protocol and have pronounced in the field. Why go screaming down the road, trying to do CPR to go into the ER and have a doc say " yep they're dead, time is"? It's unsafe and gives a family false hope.

I've yet to have a complaint that we didn't take the person to an ER. We tell the family that we have done all we could, that it is the same thing an ER would have done and that we consulted with a doctor prior to stopping. So far we have been thanked for our efforts and doing all we could. Yes it still sucks to have to tell a family that but it beats the false hope of going to the ER. I try to keep the family updated while we are working as well.
 
auto pulse

I know a couple of services who have gotten rid of this device. If you take a rescue annie and lay her down on it, and place a rescue randy on top....place the band around the waste and turn it on.......very funny but other then that.
 
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