Lucas device vs Autopulse [Archive] - Glock Talk

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Greenglock21
04-03-2007, 07:54
I would like to hear the experiences and opinions of those folks that have worked with either the Zoll Autopulse or the Medtronic Lucas Device. Ultimately, I'd love to hear a "street" analysis of which device has the best results, and which device is the most user friendly.

Thanks,

Fred
York County Fire and Life Safety

D25
04-04-2007, 11:42
I am a big fan of the Autopulse. I almost forgot that is what it is really called, it's name on our rigs is the geezer squeezer. We have experienced a signifigantly higher rate of ROSC with it, and a slightly higher rate of post arrest hospital discharge. These results are in a fairly low volume service, but seem on par with the bigger experiments that the Zoll guy will be more than happy to tell you about.

It is relatively non-obtrusive while you're doing your thing, although contrary to what the Zoll guy will probably say, you will need to have someone doing good old fashoned chest compressions while you intubate, unless you can tube a basketball while someone is dribbling it. Plus it frees up room when you're in the box. No more climbing over people while careening down the road.

It's intuative to set up. The people around here that have a hard time putting on gloves or changing a lightbulb can do it.

It is heavy. But that just insures that it won't be broken 15 min. after I get my hands on it! :supergrin:

GusDog
04-04-2007, 19:09
My service were involved in the initial auto pulse study. My impression was similar to the conclusions of the study - The Auto Pulse in junk - inefficiant and unneeded. We had them for about 6 months a few years ago - busy service - they got lots of use.

D25
04-05-2007, 10:20
Originally posted by GusDog
My service were involved in the initial auto pulse study. My impression was similar to the conclusions of the study - The Auto Pulse in junk - inefficiant and unneeded. We had them for about 6 months a few years ago - busy service - they got lots of use.

Inefficient how? Unneeded? If your service was part of the first autopulse study, then you may need to reread the conclusions of the study. After all, ROSC and hospital discharge are what we are after when we run a code, and the numbers aren't really a matter of opinion. What exactly didn't you like?

GusDog
04-05-2007, 12:47
First of all look at the methodology of the study - now my memory on this may not be perfect, BUT - the control group was 5 minutes of BLS only CPR, and the study group went right to the Autopulse (or auto-puker as we called it) with no monitor, airway adjuncts, etc, until the autopulse did it's thing for 5 minutes. Give me a day or two to go back and look through some of our materials from the study to refresh my memory.

The unit was prohibitivly heavy. We are a municipal 3rd service, so we don't get a whole engine company to an arrest - 2 medics, maybe a supervisor, maybe a cop or two. So now we have to carry the lifepak, jumpkit, O2, LBB, collar bag, suction, and a 75lb rib shattering monstrosity that does not do compressions any better than your average medic student or cop.

As I said, my dislike of the Autopulse is based on my experience with it during the initial study. Unfortunatly my memory of the specifics are a little cloudy, but the bad taste is still there. As I remember it very few of the providers in the study cared for it, and the CEM Docs weren't big fans either. In fact the only ones I remember being impressed with the thing were the reps from Zoll. Like I said, I know I'm just talking out of my a** until I get some facts, I will, give a day or two.

Wait, here's some quick quotes from an artical on the Aspire study (which my service was a part of)...

In the JAMA article, the researchers report that the AutoPulse CPR device did not improve survival rates for patients in out-of-hospital cardiac arrest and in some cases, was associated with worse neurological outcomes in survivors. Because of these findings, the trial was terminated early by the study investigators.

There was no significant difference in survival rates four hours after the 911 call between the manual CPR group and the AutoPulse CPR group (29.5 percent vs. 28.5 percent). Survival to hospital discharge was lower in the AutoPulse CPR group (5.8 percent vs. 9.9 percent) as was survival with good cognitive function.

JAMA ASPIRE artical (http://www.upmc.com/Communications/NewsBureau/Research/Articles/ManualCompressions.htm)

You're right, the numbers don't lie...

From JEMS
Contrary to the smaller studies, this gold-standard ASPIRE trial concluded that the use of AutoPulse "as implemented in this study was associated with worse neurological outcomes and a trend toward worse survival than manual CPR."

JEMS AutoPulse artical (http://www.jems.com/jems/31-10/240393/)

So the evidence on the AutoPulse is inconclusive at best. I stand behind my opinion on the device based on my experience - JUNK!

D25
04-05-2007, 13:10
When you said "initial", I figured that you meant the first one. The ASPIRE study happened quite a bit down the road, and was pretty signifigantly flawed. How many times did your protocols change during the "study"? But we are neither statistical analyists, nor Zoll reps, so it dosn't really matter.

So other than the numbers, which are debatable (by the aforementioned stats guys and Zoll guys), the only thing that you didn't like is that it's heavy?:upeyes:

GusDog
04-05-2007, 13:35
Not just heavy, but prohibitivly heavy. If the device was the miracle worker it's claimed to be it might be worth the weight. If it was 1/4 of it's weight it might be worth using a largely unproven device of marginal effectiveness. Adding 75lbs to the 20lb LBB with a 250-300lb pt on it just isn't smart or safe or practical for many departments.

Most patients subjected to the device ended up with pulverized sternums and rib cages, and the horrific crunching of bone and cartilidge was often heard by family members.

Ever squeeze a ketchup packet until it burst? That was often the effect the AutoPuker had on the human body - causing every possible bodily fluid to be forced out of the mouth and nose often at high pressure and velocity posing a significant safety hazard for providers and bystanders alike.

The compression strap did not fit people of all sizes well, and on the very small and very large could easily become a noose.

It's cumbersome, and the space it takes up could be used to carry gear that actualy works.

It's cumbersome and difficult to get many patients onto - poor design.

It's cumbersome and difficult to set up and work with - again poor design.

This whole topic is just another symptom of the public's, and consequently EMS's, fixation on cardiac arrest survival rates as a measure of our overall effectivness. The most recent, and conclusive, studies prove that the biggest influence on out of hospital cardiac arrests are bystander CPR and early defib - things often out of our control. I'm not down playing the importance of attempted rescusitation of cardiac arrest victims, but the outcome of the these patients is a poor poor measure of EMS's overall effectivness, and there are many areas of our operations and patient care that better deserve all the attention and resources.

D25
04-05-2007, 13:55
OK. I was curious, not trying to ride your *****. It is cumbersome, but from what I experienced in a service similar to the one you described- ie- no truck company, just 2 medics nad maybe a cop, it was an extra set of hands (that didn't get tired during the 20 min. transport) which seemed to work out well.

BTW, ours weight 28#, were you using some prototype?

GusDog
04-05-2007, 14:00
Originally posted by D25
OK. I was curious, not trying to ride your *****. It is cumbersome, but from what I experienced in a service similar to the one you described- ie- no truck company, just 2 medics nad maybe a cop, it was an extra set of hands (that didn't get tired during the 20 min. transport) which seemed to work out well.

BTW, ours weight 28#, were you using some prototype?

It was a few years back, and my memory is foggy. And I didn't mean to get snippy, but 6 months of steady midnights makes me a little testy sometimes. I'll see what I can dig up about the autopulses at work tonight.

D25
04-10-2007, 09:10
GD, did you find anything out?

SLIDER in KY
04-10-2007, 21:48
Our service has had the AutoPulses for about 8 months now. There has been a very big increase of ROSC on our codes. Personally, I think they are GREAT!! It frees up a set of hands that probably needs to be doing something else.

Greenglock21
04-12-2007, 08:22
I'd like to thank everyone for submitting their experiences and opinions- they're exactly what I'm looking for.

Fred