County approves automated CPR devices

Sussex County paramedics will get an extra hand, or two, from new automated devices approved by the Sussex County Council on Tuesday. The council unanimously approved the purchase of 11 LUCAS Chest Compression System devices, an external medical device that provides chest compressions during cardiopulmonary resuscitation (CPR), after receiving a recommendation that the devices would make CPR better and safer for everyone involved.

The LUCAS devices include a band that wraps around the patient’s chest and use that band to perform compressions that otherwise would be done by the paramedic, even while in transit in an ambulance.

Glenn Luedtke, director of Sussex County Emergency Medical Services, noted that his department had been researching such devices for several years and was finally ready to make a recommendation to the council on their purchase.

“Sudden cardiac arrest kills 250,000 people annually,” he reported. “And we have 200 to 250 such cases a year,” he said of patients treated by SCEMS.

Luedtke pointed out that recent research had emphasized the need for high-quality CPR, versus the simple need to provide CPR as best as a rescuer might be able.

“Quality contributes to the result,” he said. “We used to go in and defibrillate immediately, but now we do two minutes of CPR first.”

Luedtke said studies had shown that the average provider can’t maintain the highest quality of CPR chest compressions for more than a minute or so, especially now that standards call for 100 compressions per minute, all of them a little deeper than were once the standard.

“You just flat-out get tired,” he said.

And while that new standard calls for EMS workers to provide two minutes of CPR right off the bat, “Research shows [rescuers are] not terribly efficient after the first minute,” due to the precision and exertion high-quality CPR requires of them.

With the LUCAS devices now available to automatically perform high-quality chest compressions, “They allow for continuous CPR without a break,” said Luedtke.

In addition, he noted, the devices also work to address safety concerns for both patient and paramedic.

“During ambulance transport, it’s not possible for the rescuer to be held firmly in a seat,” he noted of in-transit CPR. “They have to stand over the chest to perform compressions. And any sudden move can place you at risk. That results in interruptions. It makes it less effective. And it can reduce the possibility you will get the patient back.”

With the LUCAS device performing compressions automatically, he said, rescuers can remain safely seated and can use their hands do advanced life-support maneuvers while in transit.

Alan Barnes, the professional standards manager at SCEMS, told the council he had been looking at the devices for about five years, considering two different devices as the EMS moved toward testing and a possible purchase.

The two main differences between the LUCAS device and the other device tested by SCEMS, Barnes said, is that LUCAS’ compressions are powered by compressed air, while the Autopulse device is powered by batteries, and that LUCAS has no disposable supplies, while the $120 compression band for Autopulse must be thrown away after each use.

With LUCAS, which is manufactured by Physio-Control – the makers of the monitors SCEMS uses now – regular use only requires EMS workers to refill the compressed air cylinders, which they can do at local fire companies.

Barnes said SCEMS’ trials of both systems had begun about a year ago. Physio-control supplied eight units that have since been used on 51 patients. SCEMS also tested four Autopulse units for three months, over the winter, before asking paramedics to fill out a questionnaire on their experiences.

“We thought people were going to prefer the other device,” Luedtke said, “but 60 percent preferred the LUCAS device.”

He noted that the small trial study had shown an increase in the number of patients with spontaneous increases in circulation versus standard CPR, but he emphasized that their sample size was small. Still, the devices were considered a substantial improvement by paramedics.

Ocean City, Md., paramedics are already using the units, Luedtke added, while paramedics in Kent and New Castle counties are currently doing the same kind of research Sussex has just completed.

“These things do a better job of CPR in the back of an ambulance than a person can do,” said Luedtke. “They do a better job of CPR period. And it’s safer for everyone.”

The council voted unanimously on May 19 to approve the purchase of 11 of the LUCAS units, one for each ambulance and supervisory vehicle SCEMS operates, plus a spare unit, for $165,000 – a $29,000 discount negotiated with the manufacturer.

State grant-in-aid funding will provide 40 percent of that cost, resulting in a $97,000 final cost to the county. Luedtke noted that SCEMS had saved up for the expense and had the funding available.