LUCAS Device for CPR

[thegenius]

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Larik, et. al. Comparison of manual chest compression versus mechanical chest compression for out-of-hospital cardiac arrest: A systematic review and meta-analysis. Medicine 103(8)😛 e37294, February 23, 2024

I stumbled across this systematic review and meta-analysis of manual vs. mechanical (e.g. LUCAS) CPR device. The meta-analysis has n=111,000 patients across 24 studies. The results were

No statistically significant differences between manual and mechanical CPR For
- obtaining ROSC
- survical to hospital discharrge
- short-term survival
- long-term survical.

Also, and more importantly, manual chest compression was associated with significalty superior neuro outcomes (OR 1.41, 95% CI 1.07-1.84, P=0.01). This means patients receiving manual CPR had 41% higher odds of favorable neurological outcomes compared to those receiving mechanical CPR.

Seems like there is no point in using mechanical CPR devices in almost all cases. Certainly not in the ED where we have multiple hands ready to do CPR.

Are folks on here aware of this study? (I was not, and I thought that for the most part mechanical CPR was non-inferior to manual.)

And are people working in ER's that no longer use LUCAS to do CPR?

 

[AlmostAnMD]

Laziness

 

[EMdoc235]

Laziness

Our ER nurses and technicians prefer a hands-off approach to pretty much everything.

 

[Apollyon]

Laziness

At the same time, the teaching is, if you're not fatigued after 2 minutes of performing CPR, you're not doing it right.

Also, my anecdotal experience was only paid crews (i.e. 2 person) were using the Lucas.

 

[JacobMcCandles]

I think it’s a good option pre-hospital for EMS crews but I immediately remove them once they’re in the ED.

 

[TooMuchResearch]

I definitely don't have enough staff most places to rotate out chest compressors.

 

[southerndoc]

We use a ResQCPR system on-scene (ResQPump and ResQPod -- provides active compression-decompression CPR). Our survival to hospital discharge numbers nearly doubled with adoption of that. However, during transport, we switch to a LUCAS device because it's not safe performing manual CPR in a transport vehicle.

I'm a big advocate for termination of resuscitation onscene instead of transporting. However, it doesn't always work out that way. We provide ALS first response and have two private transport agencies in the county where I work.

 

[Apollyon]

I was thinking more about the "why". One possibility is the "one size fits all" of the Lucas. That is, the 90 year old frail woman and the fat 55 year old guy get the same compressions. The 90 year old gets all ribs broken and bilateral pneumos, so, no ROSC. The fat guy might not get anywhere near the appropriate amount. An analogy is somebody in the passenger seat, versus talking to you on the phone. If traffic is heavy or tricky, the person next to you can adjust and assist. The person on the phone has none of those clues. The two stage that @southerndoc describes above is a lot more accurate.

 

[bravotwozero]

positioning is also key, which I think would be a major confounding variable in the study findings mentioned above. Harder for the thing to stay in position the larger/more obese the patient. I've seen at least a few patients with cpr in progress that were obese with the device on their epigastric region - Pretty sure epigastric compressions are unhelpful.

 

[CajunMedic]

It was a huge deal in the EMS community when it was released. Pretty much you'll pry the LUCAS from their cold, dead, hands. Makes sense in the pre-hospital community where you may not have the help, or the scene makes it impossible to perform CPR of any kind while extricating the patient.

I'm with @southerndoc though. We're working on changing the protocols to be able to terminate in the field.

 

[southerndoc]

I was thinking more about the "why". One possibility is the "one size fits all" of the Lucas. That is, the 90 year old frail woman and the fat 55 year old guy get the same compressions. The 90 year old gets all ribs broken and bilateral pneumos, so, no ROSC. The fat guy might not get anywhere near the appropriate amount. An analogy is somebody in the passenger seat, versus talking to you on the phone. If traffic is heavy or tricky, the person next to you can adjust and assist. The person on the phone has none of those clues. The two stage that @southerndoc describes above is a lot more accurate.

The medical director sets the compression depth, but you're right -- there is no way to change it onscene. The LUCAS is only FDA approved for 18 and up.

 

[southerndoc]

positioning is also key, which I think would be a major confounding variable in the study findings mentioned above. Harder for the thing to stay in position the larger/more obese the patient. I've seen at least a few patients with cpr in progress that were obese with the device on their epigastric region - Pretty sure epigastric compressions are unhelpful.

Shoulder straps are an absolute must or the LUCAS will "walk" down toward the abdomen. We've seen liver lacerations from it before.

 

[Apollyon]

30 years ago, we had on scene declaration. Still warm, asystole, two rounds of epi and atropine, with CPR, still asystole, call med direction and request termination.

 

[RustedFox]

It was a huge deal in the EMS community when it was released. Pretty much you'll pry the LUCAS from their cold, dead, hands. Makes sense in the pre-hospital community where you may not have the help, or the scene makes it impossible to perform CPR of any kind while extricating the patient.

I'm with @southerndoc though. We're working on changing the protocols to be able to terminate in the field.

I'm glad we're friends.
Never did I think about prehospital care.
I was ready to say something comically myopic like: "Get that deformed R2D2 the hell out of here."

 

[Zebra Hunter]

We do E-CPR cases at our facility fairly frequently. I’d say about 25% of all our out of hospital cardiac arrest traffic is being activated as a potential ECMO candidates. Now obviously not all of those are being cannulated (maybe about 30-50%), but mechanical CPR is typically preferred in those cases to allow for more space in the room. Just had an inferior STEMI/V-fib arrest with a 45 minute down time wake up neurologically intact a day or two after being placed on ECMO.

 

[southerndoc]

We do E-CPR cases at our facility fairly frequently. I’d say about 25% of all our out of hospital cardiac arrest traffic is being activated as a potential ECMO candidates. Now obviously not all of those are being cannulated (maybe about 30-50%), but mechanical CPR is typically preferred in those cases to allow for more space in the room. Just had an inferior STEMI/V-fib arrest with a 45 minute down time wake up neurologically intact a day or two after being placed on ECMO.

Yannopoulis has some impressive data on E-CPR. We haven't set our program up yet.

 

[thegenius]

The data seems fairly compelling that for the average use of mechanical CPR the outcomes are no better, with worse neuro outcomes, despite the anecdotes here. The meta-analysis included some less than robust data, and your output is only as good as your input.

There might be exceptions like in an ambulance (due to lack of space), or while doing ECMO.

 

[southerndoc]

The data seems fairly compelling that for the average use of mechanical CPR the outcomes are no better, with worse neuro outcomes, despite the anecdotes here. The meta-analysis included some less than robust data, and your output is only as good as your input.

There might be exceptions like in an ambulance (due to lack of space), or while doing ECMO.

What anecdotes?

It's not really the lack of space that's the reason to use it in an ambulance. It's being able to safely have CPR in progress without a paramedic standing up in the back of a moving ambulance.

 

[thegenius]

What anecdotes?

It's not really the lack of space that's the reason to use it in an ambulance. It's being able to safely have CPR in progress without a paramedic standing up in the back of a moving ambulance.

The ones above. For instance, I think you wrote that you your hospital to discharge survival numbers nearly doubled. Most of the studies in that systematic analysis (24 total) when pooled don't show a survival benefit.

 

[southerndoc]

The ones above. For instance, I think you wrote that you your hospital to discharge survival numbers nearly doubled. Most of the studies in that systematic analysis (24 total) when pooled don't show a survival benefit.

Our numbers, which we are working on publishing, are not related to LUCAS. It's the ResQCPR system.

 

[xaelia]

Such a different scene here in NZ – our paramedics (almost never) bring anyone in with a mechanical CPR device in place. There's a lot more stay-and-play and terminate in the field with online medical control. Definitely don't miss it.

I'm not opposed to various eCPR and mechanical adjuncts to resuscitation, but they have to accompanied by refined patient selection to reduce the low-yield intervention and waste.

 

[CajunMedic]

Our numbers, which we are working on publishing, are not related to LUCAS. It's the ResQCPR system.

We were using the ResQPod years ago by itself, I had forgotten about the ResQPump, I never knew how widespread it was being used.

 

[southerndoc]

We were using the ResQPod years ago by itself, I had forgotten about the ResQPump, I never knew how widespread it was being used.

ResQPod by itself doesn't help much. The ResQPump helps, but both combined is where we saw the dramatic increase in survival to discharge.

 

[Jabbed]

Never seen the ResQPump, but it seems that it’s manually being held against the chest wall rather than strapped around like the LUCAS. At face value that fixes the main problem with the LUCAS: drifting off the LV and compressing the aortic outflow tract.