More and more, I'm seeing Facebook posts, newspaper articles, and personal testimony that excitedly describe a "LUCAS save." That is, a successful resuscitation is credited to the use of a mechanical compression device made by Physio-Control. For example:
"Saves man's life!"
"Life-saving technology!" "Saves local man!" "Thanks to LUCAS!" Why hasn't this news of Lazarus-like success swept the country? Why are we still doing CPR with our hands?
|Doing CPR with our muscles... like a sucker!|
The LUCAS doesn't save lives.
And no, I don't mean this in the clever "guns don't kill people..." sense.
I mean this in the "proven by science" sense.
The study looked at patients who had a cardiac arrest treated by EMS. They enrolled adults, who had suffered a non-traumatic arrest, and were neither too small, nor too large, to fit in the LUCAS. They randomized patients to either get manual CPR according to 2005 European ACLS guidelines, or to get chest compressions delivered by a LUCAS device.
The teams were well-trained - not only was there initial preparation for the teams with both usual and mechanical techniques, but team members had twice-yearly re-training, as well as random "spot checks" of individual participants using a manikin. Pretty rigorous!
The primary outcome was maintaining survival for 4 hours after ROSC. You can quibble that this isn't as important as, say, neurologically-intact discharge from the hospital, but it's a reasonable goal, and likely easier to achieve.
This should have been a slam-dunk for the machine. Mechanical CPR is consistently high-quality, does not fatigue, and frees up EMS workers for other tasks. One more bonus for the machine - the protocol called for defibrillations to be given during the mechanical compressions, something that humans are not usually able to do! In theory, this elimination of the peri-shock pause should have increased survival in the LUCAS-treated patients.
|LINC trial protocol|
However, after 2500 patients were enrolled, they found squat for differences between manual CPR and the LUCAS. Nothing. No matter what outcome you picked, there was no advantage to using the LUCAS. None.
|LINC trial results|
So that's the end of the LUCAS for routine management of cardiac arrest by EMS, right? We did the research, it was negative, and we took the expensive machines off the rigs. The EMS services that haven't bought them have expressed relief that they didn't lay out the cheddar.
"But the LUCAS..."
- "...delivers better CPR!"
- "...can shock during CPR!"
- "...can do better CPR during transport!"
- "...doesn't get tired!"
|The graph is explained HERE, if you're into that sort of thing.|
Don't give credit to a piece of plastic!
A recent article over at JEMS describes a successful cardiac arrest resuscitation. The authors write about the myriad contributing factors:
The integrated training between EMS responders and the CPR/AED-equipped police officers; the multilayered, coordinated response and resuscitation effort by police and EMS familiar with the pit-crew approach to resuscitation and use of a mechanical CPR device; and the rapid response and time-to-care by the rescuers—particularly at such a large gathering—were all key factors in this successful resuscitation.But the authors then go on to emphasize in the last paragraph that the LUCAS "was clearly a part of this successful resuscitation," and that "they’d never seen this type of response in all of their years of managing cardiac arrest cases."
In other words; "We did okay, but we're pretty sure that this inanimate object should get the lion's share of the glory."
You know, I think I've seen this before...
|"Simpsons already did it!"|
The Bottom Line:
You know what saves lives?
You, and your well-trained team, utilizing the proven techniques that save lives. Believe me, if the LUCAS was able to generate these sorts of results...
(For another analysis of this trial, plus some interesting comments, read the post Man vs Machine: A CPR Battle to the... over at Ryan Radecki's excellent blog.)