"New" compression device

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Permalink Reply by Ben Waller on July 2, 2009 at 9:31pm

We did a trial around 3 years ago. What we found is that there is a pretty serious interruption in CPR in order to apply it to the patient. Given that chest compressions are extremely important, interruptions are less-than-desirable. The studies show conflicting results on outcomes as well.

I had a lot of experience with the Michigan Instruments Thumper back in the day. It made long CPR cases bearable, but most of those were for patients that realistically should have been pronounced at the scene.

I'm all about finding a machine that can do CPR longer and more effectively than a person...as long as it generates better patient outcomes. That machine has to be compact, rapidly applied, minimize interruptions in chest compressions, and have clearly positive outcomes. That machine apparently has not yet been built.

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Permalink Reply by Nathan on July 2, 2009 at 9:39pm

You used this same device? Do not confuse the "thumper" with this one as the mechanism is significantly different.

Ben Waller said:

We did a trial around 3 years ago. What we found is that there is a pretty serious interruption in CPR in order to apply it to the patient. Given that chest compressions are extremely important, interruptions are less-than-desirable. The studies show conflicting results on outcomes as well.

I had a lot of experience with the Michigan Instruments Thumper back in the day. It made long CPR cases bearable, but most of those were for patients that realistically should have been pronounced at the scene.

I'm all about finding a machine that can do CPR longer and more effectively than a person...as long as it generates better patient outcomes. That machine has to be compact, rapidly applied, minimize interruptions in chest compressions, and have clearly positive outcomes. That machine apparently has not yet been built.

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Permalink Reply by Ben Waller on July 2, 2009 at 10:09pm

Nathan,

I'm not confusing the Thumper with the AutoPulse. I've used both.
They both have problems, and the studies regarding patient outcomes are mixed with the AutoPulse.
I haven't seen but one Thumper study and the outcomes it showed were pretty dismal.

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Permalink Reply by Joshua Todd on July 3, 2009 at 4:02am

I have operational real word field experience with the LUCAS device that medtronic is currently marketing. I feel that it does do much better compressions and increases the CO over manual compressions. That being said while it can be placed quickly with minimum delays in compressions you have to be very cognizant of the fact that some providers will tunnel in on the lucas (just like intubating) and spend to much time trying to position it and not doing effective compressions. You must use some form of a "team leader" concept to try and ensure that this doesn't occur.

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Permalink Reply by Joshua Todd on July 3, 2009 at 4:04am

Anecdotally I think most of us have seen a huge jump in Field ROSC with this device in conjunction with the ITD and rapid placement of a king LTS-D. That being said, I dont know yet if we are seeing any difference at all in our survival to discharge rates.

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Permalink Reply by Duncan Hitchcock on July 3, 2009 at 8:38am

Zoll Medical is in the process of a large field study in several different EMS agencies through out the country. Just to our south, a large countywide fire rescue agency is participating. In discussions with their field personnel and research coordinators they are receiving interesting reports as to it's effectiveness. To our north another countywide EMS agency has been using the AutoPulse for over a year. They were part of an earlier Zoll financed study. The results of their experiences are frequently referenced by Zoll. They are impressive results.

We have chosen to wait until the results of the large study currently under way before we seriously consider moving forward with the AutoPulse. Many years ago we had a couple Thumpers and an HLR. Those of you that used these heavy oxygen driven devices are like us and sent them to the store room or scrapped them. With the new science showing that the key to survivability is quality CPR, a mechanical device to perform this function seems inevitable.

As EMS moves its treatment decision more into the evidence based world of best practices, the research behind these types of tools becomes more important.

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Permalink Reply by Nathan on July 3, 2009 at 2:25pm

From the studies I saw presented this thing is great. you will get normal BP and near normal sao2 readings. you will get the notch in art line tracings ect. supposed to move near 100% of prearrest blood volume when the next best thing (your hands or a "thumper" type device) move only 30%, and it does not break ribs. I can see some problem with getting it on if you wait untill after you start ivs and intubate but I dont think it will be to much of a problem since we are moving away from immediately concentrating on intubating and only perform intubation when we anticipate a long code or other various reasons . Your right Duncan there is an EMS agency that has a ROSC to ER of well over 60% now! The thing I like better about this VS the "thumper" type devices is that this is battery powered, compresses for apx 45 min or more, you strap your patient to this device like a KED so we shouldn't see migration. It almost NEVER breaks ribs. This is used for post open hearts which have sternums already cut in half and wires back together and it does not damage anything since the compression is so spread out over the thorax. I know I sound like im trying to sell the thing before we even see how well it works but I cant help it the studies we were shown seem so promising! :) keep it coming guys its good info thanks! Ill post what we come up with as well, for those interested.

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Permalink Reply by Ben Waller on July 3, 2009 at 4:27pm

Nathan,

Unless you can find scientific measurement that proves that the AutoPulse moves the percentage of cardiac output that the salesman says it does, I'd file that claim in the "Sales Pitch" bin until such data is available.

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Permalink Reply by Duncan Hitchcock on July 3, 2009 at 4:58pm

We must move into the realm of scientifically valid evidence based best paractices on what we do in the field.

Just look a c-collars and traction splints and back boards. ANy body can market one of these.

We must move into the world of science and research.

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Permalink Reply by Nathan on July 3, 2009 at 8:23pm

Ya thats what I said and I asked him to send the studies, which according to him are valid. Going to have to look though.

Ben Waller said:

Nathan,

Unless you can find scientific measurement that proves that the AutoPulse moves the percentage of cardiac output that the salesman says it does, I'd file that claim in the "Sales Pitch" bin until such data is available.

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Permalink Reply by Chance Gearheart on July 3, 2009 at 10:18pm

I think the principal of a traction splint has been well established since World War I. And considering 35% of all C-Spine injuries in the United States are due to improper handleing of the patient, I think we can also argue a case for certain kinds of c-collars.

That said, I'm going to hold my judgement for the autopulse. I've talked to several PICU fellows here at my hospital, and they've said the results on arrests have been mixed, and several studies have shown results that haven't correllated with eachother. Although it looks impressive and dramatic in the videos, I'm going to withhold my judgement on it until a position paper is released by one of the medical bodies, such as AAP or AMA. I know that Baptist Memphis ER has one for resuscitations, and they swear by it. I want to see some of the studies myself, though

Nathan, can you send me some of the studies? If you will message me I'll send you my Email address.

Duncan Hitchcock said:

We must move into the realm of scientifically valid evidence based best paractices on what we do in the field.

Just look a c-collars and traction splints and back boards. ANy body can market one of these.

We must move into the world of science and research.

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Permalink Reply by Duncan Hitchcock on July 4, 2009 at 6:52am

The point of my comments on c-collars, traction splints and back boards was not to the efficacy of their use in the prehospital setting. The point was how easy it is for someone to design a new style and market it. That is, market a piece of "medical" equipment that has no scientific research to prove its safety or appropriateness. There is no oversight to many of these devices that end up on our units and being applied to patients. What studies prove that Bob Young's Medical Ergonomic Neurologic Orthopedic Widgit (BYMENOW) works or is safe?

I am not putting the AutoPulse in this catagory. Zoll is conducting clinical studies to reproduce its earlier results and claims. Until they publish the results, I won't even consider purchasing this tool.

The point is that as members of the health care community, EMS must become evidence based in the tools, procedures, protocols and treatments we use in the prehopital setting.

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