Automated compression device war turns hardcore

I received an email from a ZOLL rep this morning that had a file attachment called "AutoPulse Technical Report #3".

The report shows a crash test with a mannequin outfitted with either the AutoPulse or the LUCAS compression device.

Wouldn't you know it? The LUCAS device lost.

Ladies and gentlemen: the gloves are off!

20 Comments

  • CBEMT says:

    Hmm, how much does your device suck when you have to put together a 1 in a million scenario to establish a problem with the other guy's?

  • In all fairness, CBEMT, both devices have a Class IIb rating.

  • Ding Ding Ding! Round 1!
     

  • Forgot to add: Rule #1 in evaluating a study – Who paid for it?

  • The MacMedic says:

    Indeed, follow the money.

  • CBEMT says:

    Tom- and it will stay that way, because AHA will never recommend one over the other. 

  • Christopher says:

    Wait, why are we transporting somebody without a pulse?

  • Brandon O says:

    The AutoPulse also won the "tightening up your corset" and "rhythmically strangling those jerks at Physio" tests.

  • I actually like the idea of an automatic compression device simply because the more I study patient safety the more I realize that variability is bad. There will always be pulseless patients that need to be transported because of special resuscitation situations (e.g., hypothermia, drug overdose) or a persistent high ETCO2. Driving in an unsafe manner to the hospital, on the other hand, should not be tolerated.

  • Guy says:

    And I think it’s necessary to know that the manikin which was used for this test is made of wire mesh and it’s completely hollow.

    Fair conditions?
    I would call it cheating.

  • Guy says:

    One more: which device provides only 80 compressions per minute? I thought AHA requires 100 or more? 😉

  • Guy – what is your source regarding the manikin? As for the rate of compressions I personally think it's apples to oranges. Active compression / decompression CPR with the ResQPump also used 80 per minute in a recent trial.

  • Guy says:

    @Tom:
    We received the same letter from ZOLL a few months ago. Somewhere in the text you’ll find the type of manikin.
    We just asked the manufacturer and they told us that it’s produced to display clothes and not to “imitate” a human.

  • J says:

    I thought the jury was still our on ACDs and that one study on ACDs in PA had been discontinued due to abysmal survival rates?
    Until we can show some good studies, this is like arguing over which snake oil will kill you the least…

  • Sudden cardiac arrest has abysmal survival rates nationally, period! King County, Wake County, Boston and a handful of others are exceptions to the rule.

  • Brandon O says:

    I do like the idea of these devices for possible correctable causes of arrest. People die for a reason, and in many cases even if they aren't salvageable in the field there might be the possibility of reversing the problem if we can keep them viable for long enough. The big one here would be STEMIs — keep pumping until you can put them on the table, and maybe you get them back. I am very interested to see this practice becoming routine for more patients in more areas… I don't know how many more we'll get back, but it could be quite a few. Who knows how many of our failed saves are from late and inadequate circulation (our usual excuse), vs. the impossibility of trying to restart a broken pump without fixing it? In such cases it makes great sense to be able to strap on a device that provides continuous compressions, whereas we certainly won't be able to do the same during packaging and transport.

  • VinceD says:

    Evidently the mannequin used: www-mucklemannequins.de/fr/vfiguren.php
    I can't stand drug and device manufacturers and their attempts to spin trivial findings into positive results. If they want to do this kind of testing to refine their products and simply make it available to the interested, that's one thing, but to use it as a demonstration of superiority is pointless. I'm not familiar with the actual use of either device, but here's my list of flaws:
    1) Who cares – I've never seen data on the topic, but I'm assuming the survival rate of patients with CPR in progress who are then in a front end collision en route to the hospital is pretty much zero, I'm not too worried about a bonk on the head.
    2) Their mannequin used was a department store mannequin and not designed to simulate a human body except in outward appearance. I'm not sure how much it weighed but I'm fairly sure it was nowhere near the 150lb needed for a decent approximation of what would be holding the device in place in a real collision..
    3) It lists "spinal deformity" as some sort of significant sign, when we have already seen that the mannequin used was nowhere near an approximation of an actual human.

    For the curious, from my out of practice engineering/physics (someone correct me if I'm wrong), the 10-g acceleration they used is approximately equivalent to a car stopping from 30mph over 3 feet, 45mph over 6 feet, or 60mph over 13 feet, so it's actually a pretty good model of a mid-speed collision. The one useful take-away point is that once the LUCAS device is dispaced from the chest, it will keep pumping and possibly cause injury to the abdomen and lower rib, a known downside of that model.

    Thanks for sharing Tom, it's interesting to see how these companies will try and exploit every tiny finding to leverage an advantage over their competition. It's not necessarily wrong to do, it just always strikes a bad chord with me.

  • AW says:

    I'd rather take a firefighter with me on the rare occasion that I choose to transport in arrest.  🙂

  • AxelFoley says:

    I agree with Vince. Imagine the scenario of a front end collision WITHOUT either of these CPR devices and replace them with the unbelted-and-unable-to-hold-on-to-a-grab-bar-while-performing-chest-compressions-firefighter AW mentioned.
    The patient has a huge chance of dying in both scenarios. But the firefighter would possibly survive only one of the two.
    My point is: Patient safety is important, but we need to put things into perspective. To mind, there's no arguing against the fact that EMS-professionals are way better off with either a LUCAS or an AutoPulse when transporting someone in need of resuscitation.

  • 9-ECHO-1 says:

    I agree with the comment "who paid for the study?" I have little faith in any study connected directly to the manufactuere or creator of a product/concept. With that said, I think there is a place for these devices, just not what was intended.
    I think it takes too long to get these devices in place for initial treatment of sudden cardiac arrest (SCA). We have seen here in Wake County (NC) good results with fast initiation of manual chest compressions. Simply put, it takes way too long to get the device in place.
    However…
    Something that we have started here is the concept of remaining on scene up to 10 minutes after ROSC, since our experience has been that the patient will re-arrest within that 10 minutes, and we would rather address that problem in the living room, with lots of room and help, rather than in the back of a moving ambulance (where we know it is not safe to travel unrestrained) with limited room and help. I think the potential for this device is the application after we obtain ROSC. That way, if re-arrest occurs while en route to the hospital, compressions can be initiated without trying to travel with unrestrained personnel in the back of the ambulance.
    Just my $0.03.

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