The Efficacy of LUCAS in Prehospital Cardiac Arrest Scenarios: A Crossover Mannequin Study

High-quality cardiopulmonary resuscitation (CPR) is critical for successful cardiac arrest outcomes. Mechanical devices may improve CPR quality. We simulated a prehospital cardiac arrest, including patient transport, and compared the performance of the LUCAS™ device, a mechanical chest compression-d...

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Bibliographic Details
Published in:	The western journal of emergency medicine Vol. 18; no. 3; pp. 437 - 445
Main Authors:	Gyory, Robert A, Buchle, Scott E, Rodgers, David, Lubin, Jeffrey S
Format:	Journal Article
Language:	English
Published:	United States Department of Emergency Medicine, University of California, Irvine School of Medicine 01-04-2017 eScholarship Publishing, University of California
Subjects:	Ambulances cardiac arrest prehospital Cardiopulmonary Resuscitation - instrumentation Cardiopulmonary Resuscitation - methods Clinical Competence Cross-Over Studies Emergency Medical Services - trends Emergency Medical Technicians - standards Equipment Design - instrumentation Guideline Adherence Guidelines as Topic Humans Manikins mechanical CPR Out-of-Hospital Cardiac Arrest - therapy Pennsylvania Prehospital Care Reproducibility of Results resuscitation Signal Processing, Computer-Assisted - instrumentation Time Factors Treatment Outcome
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Summary:	High-quality cardiopulmonary resuscitation (CPR) is critical for successful cardiac arrest outcomes. Mechanical devices may improve CPR quality. We simulated a prehospital cardiac arrest, including patient transport, and compared the performance of the LUCAS™ device, a mechanical chest compression-decompression system, to manual CPR. We hypothesized that because of the movement involved in transporting the patient, LUCAS would provide chest compressions more consistent with high-quality CPR guidelines. We performed a crossover-controlled study in which a recording mannequin was placed on the second floor of a building. An emergency medical services (EMS) crew responded, defibrillated, and provided either manual or LUCAS CPR. The team transported the mannequin through hallways and down stairs to an ambulance and drove to the hospital with CPR in progress. Critical events were manually timed while the mannequin recorded data on compressions. Twenty-three EMS providers participated. Median time to defibrillation was not different for LUCAS compared to manual CPR (p=0.97). LUCAS had a lower median number of compressions per minute (112/min vs. 125/min; IQR = 102-128 and 102-126 respectively; p<0.002), which was more consistent with current American Heart Association CPR guidelines, and percent adequate compression rate (71% vs. 40%; IQR = 21-93 and 12-88 respectively; p<0.002). In addition, LUCAS had a higher percent adequate depth (52% vs. 36%; IQR = 25-64 and 29-39 respectively; p<0.007) and lower percent total hands-off time (15% vs. 20%; IQR = 10-22 and 15-27 respectively; p<0.005). LUCAS performed no differently than manual CPR in median compression release depth, percent fully released compressions, median time hands off, or percent correct hand position. In our simulation, LUCAS had a higher rate of adequate compressions and decreased total hands-off time as compared to manual CPR. Chest compression quality may be better when using a mechanical device during patient movement in prehospital cardiac arrest patient.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	1936-900X 1936-9018
DOI:	10.5811/westjem.2017.1.32575