Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

The LUCAS, Research, and Wishful Thinking


 

Does the LUCAS improve outcomes?

No. The authors state that clearly.[1]

Do people think that we should use the LUCAS anyway?

Yes. The excuses are presented by many people.

What are the possible benefits?

1. The LUCAS allows us to free up a pair of hands to do other things that do not benefit the patient, so this adds nothing useful.

2. The LUCAS allows us to transport the patient safely. This is a rehash of #1, since routine transport does not improve outcomes.

3. Treatment will be consistent, regardless of the quality of the EMS. Rather than improve quality, we will have a machine take over something we think is done poorly, so that EMS can harm the patient by doing other things poorly.

4. The LUCAS can take over one of the two treatments that can improve outcomes. An AED can take over the other. We no longer need to have EMS respond to cardiac arrest calls until after ROSC (Return Of Spontaneous Circulation).

If the dramatic success of Seattle is due mostly to the frequency of bystander CPR, that would suggest that the best use of the LUCAS is in the hands of bystanders, not EMS.
 


 

If that is too much adult material, we can do the version for kids.
 

[youtube]Ff_kalDZfzU[/youtube]
 

Or we can do the version for toddlers.
 


 

If EMS cannot manage that, should we be giving them equipment to free them up to mess up intubation or drugs or other things that do not improve outcomes.

Why are we so eager to add treatments that do not help patients?

Ethical patient care means limiting ourselves to treatments that improve outcomes.
 

Dr. Brooks Walsh also explains the failure of the LUCAS in this study in “We had a LUCAS save!” – No, you didn’t.

Also see –

The Failure of LUCAS to Improve Outcomes in the LINC Trial

Footnotes:

[1] Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial.
Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, Halliwell D, Box M, Herlitz J, Karlsten R.
JAMA. 2014 Jan 1;311(1):53-61. doi: 10.1001/jama.2013.282538.
PMID: 24240611 [PubMed – indexed for MEDLINE]
 

The current sample size has a 95% confidence interval for the 4-hour survival ranging from −3.3% to +3.2%. Translated another way, while the point estimate for treatment effect was near 0.0, our study could not rule out the possibility of a 3.2% benefit or a similarly sized harm from mechanical CPR relative to standard CPR.

 

Not just not helpful, but this could be harmful.

.

Comments

  1. The first study I saw on the Lucas, IIRC, indicated it was at least as effective as manual compressions. Which indicated that all things being equal, it was a convenience that kept me and others from being glued to the patient’s chest. But with this study not being able to conclude that there isn’t a drop-off in stabl ROSC rates, I’m hard-pressed to justify the convenience factor. The Saussey study in 2010 concluded a 71% increase in stable ROSC rates with use of of the Lucas in conjunction with an ITD and field-induced hypothermia (long-term survivability had not yet been studied). But after seeing this study, and with what we’re seeing with with studies of field-induced therpuetic hypothermia, it looks like those results are solely because of impedence threshold devices like the ResQPod.

  2. So, based on those studies, and others we’ve seen, good quality CPR, defibrillation when necessary, and maybe we need to look at ITDs and not LUCAS/AutoPulse/Thumper? Maybe the ITDs will help, but maybe the ROSC we get from ITD is more of a surrogate endpoint, but I suppose more research isn’t a bad thing.

  3. The autopulse is DoA. The first comprehensive study on post–discharge survival rates was abandoned after poorer outcomes were trending. This study is actaully within a margin of error. I’m not married to the Lucas. Not by any means. But it offers something that I can’t accomplish with a human, and that’s the potential for continuous quality compressions in situations where either manpower is limited, or in the times when patient movement precludes it (moving the patient down a flight of stairs on a backboard, etc). So I’d like to see more studies that use more comparitive factors. Is a Lucas with an ITD synergistic? Is the reason why it isn’t as effective as people hoped because it allows too much intrathoracic pressure to build? I want more information.

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