Cardiac & Resuscitation

Mechanical CPR is Producing Resuscitation Results Beyond Expectations

The Memphis Fire Department (MFD) and Richmond (Va.) Ambulance Authority (RAA) have a lot in common. Both services are innovators in EMS, have an enthusiastic staff that continues to implement ways to improve the care they render to their patients and both have been searching for ways to improve their resuscitation success rates.

Each also believes they’ve found that way by implementing mechanical CPR in their agency. MFD uses the Physio-Control LUCAS 2 chest compression system and RAA uses the ZOLL AutoPulse non-invasive cardiac support pump.

Though they’re using different devices, their results have been dramatic and have convinced their medical and administrative leadership that mechanical CPR offers many benefits over manual CPR, not the least of which is the ability to maintain consistent and uninterrupted CPR—a key ingredient in the successful resuscitation and discharge of patients neurologically intact from the receiving hospital.

MFD and RAA are both keenly aware that sudden cardiac arrest (SCA) is a leading cause of death among adults over the age of 40 in the United States, that approximately 424,000 people experience EMS-assessed out-of-hospital nontraumatic SCA annually (more than 1,000/day) and nine out of 10 victims currently die.1

The number of people who die each year from SCA is roughly equivalent to the combined number of people who die from Alzheimer’s disease, assault with firearms, breast cancer, cervical cancer, colorectal cancer, diabetes, HIV, house fires, motor vehicle accidents, prostate cancer and suicides combined.

SCA can be best impacted by early intervention with cardiopulmonary resuscitation (CPR), defibrillation, advanced cardiac life support, therapeutic hypothermia and other measures of comprehensive post-resuscitation care.
When bystanders intervene by providing early, high-quality CPR and using automated external defibrillators (AEDs) before EMS arrives, four out of 10 victims survive.1

This article will detail the path each service has taken to success in implementing mechanical CPR on their frontline ambulances.

The MFD Experience

The MFD, the largest EMS system in the state of Tennessee and the Midsouth, responds to more than 121,000 EMS calls annually. MFD is an all advanced life support (ALS) system that operates 36 ALS ambulances, 56 ALS engines, and 21 BLS ladder truck companies with a staff of 500 firefighter/paramedics and 1,100 firefighter/EMTs. The department operates 98 pieces of fire apparatus that are ALS capable. ALS response times average just over four minutes.

In addition to teaching a paramedic education program, MFD is a certified American Heart Association education center, and the only fire department in the U.S. authorized by the Continuing Education Coordinating Board for Emergency Medical Services to issue their own CEUs.

Operating one of the most progressive EMS systems in the U.S. means utilizing some of the latest treatment protocols and procedures. This includes induced hypothermia and mechanical CPR devices for cardiac arrest patients, continuous positive airway pressure for congestive heart failure patients, and intraosseous infusion for intravenous fluid access.

The Assisi Foundation provided the Memphis Fire Department with grant funds to ensure every MFD ambulance was equipped with a LUCAS 2 mechanical CPR device.

The Assisi Foundation provided the Memphis Fire Department with grant funds to ensure every MFD ambulance was equipped with a LUCAS 2 mechanical CPR device. Photo Roger Cotton

 

MFD also has an aggressive ST elevation myocardial infarction (STEMI) program with an average time of 65 minutes from first paramedic contact-to-balloon in a hospital cardiac catheterization lab.

The city of Memphis is in the heart of the cardiovascular disease belt, rating high on the incidences of heart disease and strokes, according to the American Heart Association. In addition, a 1994 study published in the Annals of Emergency Medicine found that the level of bystander CPR was significantly lower for African-Americans in Memphis when compared to whites.2 In addition, the traditional social morays prevalent in this region result in a large percentage of patients in cardiac arrest being transported.

Focus on Improving SCA Outcomes

Prior to 2012, the MFD initiated several changes to improve patient outcomes for sudden cardiac arrest. MFD first focused on quality CPR with effective compressions. EZ-IO intraosseous infusion drills and King Airways were added in an effort to reduce the times that compressions were being interrupted. Hypothermia treatment was also initiated in the field. Return of spontaneous circulation (ROSC) rates increased, but MFD continued to look for ways to improve patient outcomes.

In 2011, MFD piloted various mechanical CPR devices, examining cost, crew choice, outcomes and support logistics eventually selecting the Physio-Control LUCAS 2.

Initially, MFD budgetary constraints allowed only 18 devices to be purchased. The devices were deployed randomly throughout the city.

During the first year of deployment, no additional changes were made in protocol or procedure. Detailing of medics resulted in use of the product by a large majority of MFD paramedics.

At the completion of the first year, a comparison between those utilizing the mechanical CPR device and those without revealed a large increase in ROSC rates among patients treated with mechanical CPR.

In determining ROSC rates, MFD included all full arrests where CPR was attempted. While some departments have exclusion criteria for ROSC rates, MFD prefers to include all medical and trauma full arrests in order to more accurately gauge performance, including all heart rhythms.

MFD personnel performed CPR on a total of 1,204 patients in 2012, with ROSC occurring in 250 (21%) of those cases. The LUCAS 2 device was used on 114 full arrests, with ROSC occurring in 37 of those cases. This equaled a ROSC rate of 32% on the LUCAS 2 resuscitations, 11% higher than the overall average for the year.

This substantial improvement in patient care prompted an aggressive effort to fully implement the LUCAS 2 device on all MFD ambulances. To do so, the MFD partnered with the Assisi Foundation of Memphis, a foundation that serves nonprofit organizations working to improve Memphis and the Midsouth.3

Due to the initial success with LUCAS 2 devices, the Assisi Foundation provided grant funds to outfit the remaining MFD ambulances with the mechanical CPR devices.

In 2013, with all 35 ambulances equipped with the LUCAS 2 device, the overall ROSC rate rose to 31%, a 10% increase over the previous year. MFD personnel performed CPR on a total of 1,134 patients in 2013, with ROSC occurring in 348 (30%) of those cases. However, for those receiving mechanical CPR, the ROSC rate was an astounding 49%!

The devices are now widely hailed by MFD paramedics, who feel the impact of the device has been profound. Cardiac arrest care now seems less stressful and more organized. And clearly the results speak for themselves.

What Makes the Difference

The MFD medical direction, training and quality assurance team believes the difference is resuscitation results and ROSC improvement is a result of the consistency of CPR delivery. Despite having plenty of personnel on scene at cardiac arrests, there was always a lack of consistency between the quality of first responders CPR, frequency of compressor rotation and frequent pauses in CPR.

These pauses often occurred for inventions to be performed, but also occurred due to patient movement to locations more conducive to CPR or transportation to the ED.

Despite CPR feedback after the call, improvements were hard to maintain. Training wasn’t frequent enough.

Knowing that the three most important aspects of high-quality CPR are a compression fraction of 90%, a compression rate of 110, and a compression depth of 2 inches, the MFD found that the LUCAS 2 provided the consistency that their system lacked. At the MFD’s 2014 EMS Star of Life reception, nearly every cardiac arrest survivor present had benefited from the LUCAS 2 device. One woman had actually been successfully resuscitated twice in two months with the device.

And the results continue to drive change; EDs in the Memphis area are now adding mechanical CPR. Cardiologists in Memphis are also now performing cardiac catheterization while the LUCAS 2 device helps maintain a pulse.

The RAA Experience

The Richmond Ambulance Authority (RAA) is a high-performance EMS system that’s well-known for technological innovation, operational efficiency and research focusing on CPR, field management of major traumatic injury and safety.

Richmond Fire & EMS provides primary first response and automated external defibrillator care and RAA functions as the sole, all-ALS ambulance provider in the city of Richmond. Fire crews are positioned conventionally in fire stations while RAA’s ALS ambulances are positioned dynamically 24/7 throughout the city using advanced system status management (SSM) that bases the unit placement on data analysis of where the most likely next life-threatening call will occur.

The SSM strategy, refined by more than 24 years of experience, is extraordinarily effective, resulting in an ALS-response time interval to scene consistently greater than 90% in all sectors of the city in 8 minutes, 59 seconds or less.

In 2004, RAA added ZOLL AutoPulse load-distributing band chest compression devices on all of its ALS ambulances. The RAA protocol calls for early application of the device during resuscitation when there’s still maximum patient viability.

RAA has found that the primary advantage of the device is that it provides consistent, high-quality, minimally interrupted chest compressions that can be maintained during defibrillation and, on rare occasions when required, during patient transport. It can be applied quickly by a well-trained crew.
In a before/after implementation of mechanical chest compression comparison, RAA demonstrated a significantly improved survival to hospital discharge.

However, RAA was cautious to point out that, in its “control period” prior to deploying the mechanical device in 2004, the quality of manual CPR being performed was highly variable. Thus, RAA hypothesized that much of the improvement seen in survival might represent the difference between not-so-well-performed manual CPR (as was the case in most EMS systems and hospitals prior to 2004) vs. consistent, high-quality, mechanical chest compression.

This hypothesis has proven to be well-founded. In a follow-up clinical trial, 522 randomized out-of-hospital cardiac arrest patients in three U.S. and two European sites compared high-quality manual CPR using real-time feedback vs. load-distributing band chest compression with the AutoPulse device.

Sustained ROSC, 24-hour survival and survival to hospital discharge were statistically equivalent. The 20-minute CPR fraction (the % of time each minute that chest compressions were being performed) in the trial was excellent in both groups (80.4% for AutoPulse and 80.2% for manual CPR).

Clinically Proven

The RAA conclusion is that mechanical chest compression with devices such as the AutoPulse can at least equal survival outcomes seen with optimally-performed CPR in a clinical trial setting with highly trained crews using real-time quality of CPR feedback devices. However, in the more typical EMS environment, mechanical CPR devices can deliver consistent, high-quality chest compressions over time with minimal interruption in blood flow.

In addition, these devices lessen the physical exhaustion that can occur when manual CPR needs to be sustained for more than a few minutes, and allow rescuers to focus their attention on other important tasks during resuscitation. 

References

1. Newman MM. (n.d.) About SCA. Sudden Cardiac Arrest Foundation. Retrieved March 6, 2014, from www.sca-aware.org/about-sca.

2. Brookoff  D, Kellermann AL, Hackman BB, et al. Do blacks get bystander cardiopulmonary resuscitation as often as whites? Ann Emerg Med. 1994;24(6):1147–1150.

3. Assisi Foundation. (n.d.) Our mission is effective philanthropy. Retrieved March 6, 2014, from www.assisifoundation.org.

4. Ong ME, Ornato JP, Edwards DP et al. Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation. JAMA. 2006; 295(22):2629–2637.

5. Wik L, Olsen JA, Persse D, et al. Manual vs. integrated automatic load-distributing band CPR with equal survival after out-of-hospital cardiac arrest. The randomized CIRC trial. Resuscitation. 2014; 85(6):741–748.

 

DRAMATIC MECHANICAL CPR SAVES
 
32 shocks & 2 hours, 45 minutes of LUCAS 2 mechanical CPR
 
In August 2013, 56-year-old Tim Franko was clearing brush in 90-degree heat at his place of employment. He had been feeling terrible and tried to cool off in front of a shop fan at the end of his shift, but he continued to feel terrible and eventually collapsed. His boss started CPR within one minute of his collapse and called 9-1-1.
 
St. Paul Fire Department paramedics worked him on scene with multiple defibrillations, medications and mechanical CPR with the Physio-Control LUCAS 2 chest compression device. While working on him the paramedics noticed that his eyes were open and they started communicating with him with eyes blinking.
 
Neurologic responsiveness is becoming a fairly frequent occurrence with the advent of mechanical cardiac compression devices because of the devices’ ability to increase blood flow through the heart and to the brain. 
 
R.J. Frascone, MD, FACEP, demonstrates the LUCAS 2 device
R.J. Frascone, MD, FACEP, demonstrates the LUCAS 2 device following a spectacular save where a man received more than 2 hours, 45 minutes of mechanical CPR. Photo courtesy KARE/MPR News
 
 
Recognizing his neurologic responsiveness, paramedics moved him quickly to the ED at Regions Hospital in St. Paul where staff continued the resuscitation with the LUCAS 2 for another hour and 45 minutes, all the while not giving up because of Franko’s obvious neurologic responsiveness.
 
With his ECG showing a large anterior STEMI, he was brought immediately to the cath lab where he promptly arrested again. Interventional cardiologist Johannes Brechtken, MD, decided to perform the catheterization while the LUCAS 2 was running. Dr. Brechten cleared out the 100% LAD (the classic widow-maker lesion) and the patient then converted to a stable sinus rhythm. He was placed on hypothermia and brought to the CCU.
 
The total LUCAS 2 time in operation was two hours and 45 minutes with a total of 32 countershocks delivered, making Franko one of the longest CPR, neurologically intact survivors in the world. Upon awakening the next morning, Mr. Franko complained only of a sore chest. 
 
R.J. Frascone, MD, medical director of the St. Paul Fire Department, was instrumental in getting the LUCAS 2 compression devices in St. Paul Fire apparatus.
 
Frascone says, “All you have to do is turn on the machine. It used to be [if] a patient gets 15 minutes of CPR or 30 minutes of CPR, no shot, you might as well call it. With this device that’s clearly not the case. We now have multiple intact survivors who have undergone extended periods of CPR, with some of them like Mr. Franko, undergoing cardiac catheratization while the machine was actively doing CPR. That approach is simply not possible with manual CPR.” 
 
Frascone believes that the majority of refractory v fib rhythms, the rhythm that Franko was in, are the functional equivalent of STEMIs and if we’re going to save these patients, we have to be more aggressive in resuscitation and take selected ones to the cath lab.
 
Basic CPR still saves lives, and studies show in many cases it can be as effective as automated CPR. But in a prolonged resuscitation, Frascone says, the LUCAS 2 is taking rescue medicine beyond what anyone thought was possible. “When do we stop? It’s a problem to know when to stop because this machine does such a wonderful job. It’s a great problem to have.”
 
Third Story AutoPulse Save
 
Mike Snyder’s parents were worried about the safety of their son, Jordan, 24, while he was serving in Afghanistan.  Little did they know that it would be Mike, their 27-year-old son living nearby in Richmond, Va., who would be the one at death’s door.
 
His brush with death happened on a cold December night when Mike, his wife, Jen, her brother, Justin, his girlfriend, and two cousins returned to Justin’s apartment after the group had spent the evening at a movie followed by a late dinner. Mike said he didn’t feel well, so Jen went to get him a glass of water. By the time she arrived back at his side, Mike had collapsed and wasn’t responding.  Justin immediately called 9-1-1 while his cousin Caleb initiated CPR, setting the chain of survival into motion.  
 
With the Richmond Ambulance Authority (RAA) on the line, the family and friends put the phone on speaker so they could hear instructions from dispatcher Travis Gortney. It was Gortney’s first cardiac arrest; he had joined RAA just four months earlier.  
 
Firefighters from Richmond’s Quint 18 were the first to arrive and continued CPR until the paramedics arrived. RAA paramedic Alex Klimenko arrived with his EMT partner Jonathan Carroll, grabbed all of their equipment—including the ZOLL AutoPulse non-invasive cardiac support pump, which is part of their protocol—and ran up three flights of stairs to the apartment.
 
Mike Snyder (center) poses with paramedic Alex Klimenko (left) and EMT Jonathan Carroll.
Mike Snyder (center) poses with paramedic Alex Klimenko (left) and EMT Jonathan Carroll. Photo courtesy Richmond Ambulance Authority
 
 
Finding Mike collapsed in the doorway to a bathroom in complete arrest, they quickly placed him on the AutoPulse for continuous, consistent chest compressions.  In addition to compressions from the AutoPulse, Mike received seven defibrillating shocks.
 
“By this time, Mike had been in sudden cardiac arrest for 30 minutes, and we had worked on him for 20, using everything we had, including medication and therapeutic hypothermia,” Klimenko said.
 
After several minutes of resuscitative efforts, Snyder responded to the care and his heart converted to a stable rhythm with pulses returned. As the firefighter and ALS crew was placing Snyder on an evacuation stretcher, with the AutoPulse still in place, he lapsed back into cardiac arrest, so they reactivated the AutoPulse as they continued downstairs and to the awaiting ambulance. 
 
“Since we had the AutoPulse, we could carry him down the three flights of stairs while it continued chest compressions. Without the AutoPulse, getting him down those stairs would have been 10 times more difficult,” Klimenko said. “It continued perfusion to his brain and delivered quality chest compressions, something we wouldn’t have been able to provide without the device.”
Klimenk adds, “Without the AutoPulse, we feel the outcome would have been different. The device makes an incredible difference, which is why we kept it on him during the 12-minute lights-and-siren drive to Virginia Commonwealth University (VCU) Hospital.”
 
At VCU, Mike was transferred over to the ED staff. Although he regained a pulse, Mike remained unconscious, so he was moved to the VCU advanced resuscitation, cooling therapeutics and intensive care (ARCTIC) unit where he was cooled to 33 degrees C. 
 
After 24 hours, the ARCTIC team slowly began rewarming Mike’s cooled body and provided intensive support to ensure his ultimate recovery. He regained consciousness and was released with the ZOLL LifeVest wearable defibrillator, which monitors the heart 24/7.
 
Mike wore the LifeVest for a month until undergoing an open heart ablation procedure at VCU to correct the rogue pathway that caused his arrest. Mike was diagnosed with Wolff-Parkinson-White syndrome, an abnormal electrical pathway that can cause palpitations, dizziness and other symptoms, when he was young, after his dentist identified it as a possibility. Although rare, WPW can also cause sudden cardiac arrest. Until his near-death experience, Mike had been asymptomatic for years.
 
RAA has been using the AutoPulse since 2005 and has seen a significant increase in the number of patients who obtain return of spontaneous circulation (ROSC). Klimenko says, “The AutoPulse is easy to apply and use. It takes us under a minute to deploy.”
 
One year to the day later, Mike, Jen and their little daughter, Lily, 2½, returned to RAA, to meet and thank the rescuers who gave him a second chance at life. Mike is glad for the second chance. He told his rescuers that he was very appreciative of their fast response and care, stating, “They gave me back my life. The odds of me waking up alive and as the same person mentally and physically were so extraordinarily low. It’s just amazing. You can’t put a price on that. I get to see the sunrise every day and see my daughter smile. And I’m forever grateful to ZOLL and the team at RAA who saved my life.”
 
Too Unstable to Fly
 
During most of the year, the population of West Yellowstone, Mont., is around 1,000 people. But during the summer, up to 15,000 visitors stream into Yellowstone National Park every day through the popular entrance near Old Faithful. And, when tourism soars, so do calls for emergency services and medical care.
 
The Hebgen Basin Fire District (HBFD) serves this 300-square-mile area of rugged terrain in the Gallatin National Forest of Montana’s Southwest Rockies. During peak season, it’s not unusual to receive multiple calls at the same time for ambulances.
 
Unlike more densely populated areas, the closest hospital is 84 miles away in Rexburg, Idaho. And the closest cardiac and trauma center is 110 miles in Idaho Falls.
 
When 56-year-old local hotel maintenance worker Steve Bartlett experienced chest pains and difficulty breathing, and then lapsed into sudden cardiac arrest (SCA), he was fortunate that an HBFD ambulance equipped with a ZOLL AutoPulse non-invasive cardiac support pump responded to the 9-1-1 call to assist him.
 
Within minutes of the 9-1-1 call, Captain John Moore and his partner, Leslie McBirnie, arrived at Bartlett’s side in the maintenance shop.
 
The ZOLL AutoPulse non-invasive cardiac support pump gave paramedics a second option to save a man in rural Montana.
The ZOLL AutoPulse non-invasive cardiac support pump gave paramedics a second option to save a man in rural Montana. Photo courtesy Richmand Ambulance Authority
 
 
“He was talking with us and had the look of a very sick person,” says McBirnie. “I went to get the stretcher and when I came back inside, Moore told me that Steve just had a seizure and was unconscious. We moved Steve to our ambulance. He still had a pulse. But, about a minute later, he went into sudden cardiac arrest.”
 
McBirnie immediately started manual chest compressions, while Moore grabbed the defibrillator and shocked Bartlett. It would be the first of many times that evening that Bartlett would be shocked. 
 
They then placed the ZOLL AutoPulse on and began to deliver consistent, high-quality automated chest compressions to Bartlett. Soon after the AutoPulse was put into operation, Bartlett achieved return of spontaneous circulation (ROSC). The AutoPulse was turned off, but left in place. Minutes later, Bartlett rearrested and the AutoPulse was turned on again for four minutes. The HBFD crew then realized that a clinical pattern was developing.
 
Bartlett’s pulse was between 60 and 70 beats per minute, but it couldn’t be maintained. He next went into v tach, was shocked and converted into a sinus rhythm with frequent premature ventricular contractions. His pulse then dropped below 40 and the AutoPulse was once again turned on for another round of mechanical chest compressions.
 
A decision was then made to call Air Idaho to have Bartlett flown to the catheterization lab at Eastern Idaho Regional Medical Center in Idaho Falls. 
Moore and McBirnie transported Bartlett to a designated landing zone to meet to meet the Air Idaho flight crew, with the AutoPulse still operating.
 
Following a 20-minute drive to the landing zone, the ground and air crews agreed Bartlett was too unstable for the flight, so the flight crew joined Moore and McBirnie in the ambulance and they transported Bartlett to the town of St. Anthony, the halfway point between the landing zone and Idaho Falls, where they met an Idaho Falls Fire Department (IFFD) ambulance. 
 
There, Steve was transferred to the IFFD ambulance under the continued care of the helicopter crew. The IFFD crew and Air Idaho flight team continued the compression and ALS care for Bartlett throughout the additional 40-minute drive to Eastern Idaho Regional Medical Center.
 
At the hospital, Bartlett coded 30 times the first night in the ICU, then another 15 times the second night. He spent three weeks in the hospital and eventually underwent surgery to have a stent inserted.
 
Bartlett  recovered with no neurological deficits and returned to a HBFD Board of Directors meeting to thank Moore, McBirnie and what he called “that good-looking machine” (i.e., the AutoPulse)  that helped to save his life.
 
Asked what role the AutoPulse played when Bartlett collapsed, Moore didn’t hesitate in his reply. “It saved his life,” Moore said. “The first time we activated it on Bartlett, he had ROSC. In later attempts, we were able to once again achieve ROSC. The AutoPulse worked flawlessly, doing what it was designed to do every time we activated it.”
 
Savin’ in Memphis
 
31 Delta 2—Unresponsive Patient
 
Early in the morning on Aug. 1, 2014, 67-year-old Joyce Wynn was walking with her friend and suddenly collapsed. The call to 9-1-1 came at 5:22 a.m. for an unresponsive patient and Memphis Fire Deptartment (MFD) Engine 48 and ALS Unit 13 were dispatched. 
 
Dispatchers advised the units that a nurse was on the scene and had initiated CPR. On arrival, Engine 48 assumed patient care, continued CPR and began treatment. ALS Unit 13 arrived and deployed the LUCAS 2 chest compression system to ensure quality CPR. 
 
The patient was intubated, shocked and medicated, and she soon spontaneously regained a pulse. Induced hypothermia protocols were initiated and Wynn was transported to Methodist North where she had begun to breathe on her own by the time she arrived. 
 
Wynn was treated at Methodist North and was discharged with no deficit.
 
9 Echo 1—Patient Not Breathing
 
At 6:30 a.m. on Oct. 20, 2013, 53-year-old Pamela Greer collapsed in her living room. The 9-1-1 operator received the call at 6:34 a.m. and immediately dispatched MFD Engine 30, ALS Unit 34 and EMS Lieutenant 204. 
The LUCAS 2 chest compression system has aided the Memphis Fire Department in delivering high-quality CPR during numerous saves.
The LUCAS 2 chest compression system has aided the Memphis Fire Department in delivering high-quality CPR during numerous saves. Photo courtesy Memphis Fire Department
 
 
The 9-1-1 operator began pre-arrival and CPR instructions. The family was scared and under duress, but followed directions to the best of their ability. On arrival, Engine 30 and ALS Unit 34 assumed patient care, continued CPR and initiated treatment. ALS Unit 34 rapidly deployed the LUCAS 2 and the patient was intubated, shocked and given cardiac drugs. Induced hypothermia protocols were initiated, 12 lead ECGs were transmitted to St. Francis Park Chest Pain Center and, while en route, the patient spontaneously regained a pulse, began fighting the ET tube and breathing on her own.
 
Greer was treated and discharged without any deficits.
 
33 Delta 1—Sudden Cardiac Arrest 
at a Dialysis Clinic
 
At 1 p.m. on April 4, 2014, 58-year-old Joe Euell was receiving his dialysis treatment when he suddenly went into cardiac arrest. The nurses and staff immediately began CPR and applied an AED which delivered two shocks.
Treatment continued while the 9-1-1 system was activated. MFD Engine 11, ALS Unit 12 and EMS Lieutenant 202 were dispatched and, on arrival, assumed patient care, continued CPR and initiated treatment including early, rapid application of the LUCAS 2. The patient was intubated, shocked and cardiac drugs were administered. 
 
While on scene the patient had a return of spontaneous circulation and began to attempt to breathe. Induced hypothermia protocols were initiated in the field and Euell was transported to Methodist University, where he was treated and discharged with no deficits. 
 
9 Echo 1—Cardiac Arrest
 
On Sept. 15, 2013, at approximately 11:50 p.m., 57-year-old Edmond Leone collapsed in front of his wife and stopped breathing. The call to 9-1-1 came at 11:54 p.m. and MFD Engine 59 and ALS Unit 30 were immediately dispatched. They arrived to find the patient’s wife performing CPR.
 
The LUCAS 2 was rapidly deployed to ensure effective, high-quality CPR, the patient was intubated, shocked and had cardiac drugs administered. Induced hypothermia protocols were also initiated and, before transport to the hospital, the patient’s cardiac rhythm stabilized and regained a pulse. 
Leone was transported to St. Francis Bartlett Hospital and was ultimately discharged with no deficits.
 
10 Delta 4—Severe Chest Pain 
 
On Jan. 1, 2014, just after midnight, 54-year-old Edward Martin began complaining of a sudden onset of severe chest pain. His wife immediately called 9-1-1 and was given pre-arrival instructions. MFD Engine 54 and ALS Unit 18 were dispatched and arrived to find Martin in a very unstable condition: short of breath, diaphoretic and complaining of severe chest pain. They initiated IV and cardiac medication, and obtained, interpreted and transmitted a 12-lead ECG to Baptist Memphis Hospital’s ED—all in just 7 minutes!
 
During transport, Martin’s condition continued to deteriorate and, as ALS Unit 18 was pulling into the ambulance bay at Baptist Memphis, he went into v fib. The crew immediately shocked him and started the LUCAS 2, which helped the crew—now without the additional engine company personnel—to administer uninterrupted compressions as they worked to resuscitate the patient.
Martin regained a pulse as he was wheeled into the ED. He received definitive treatment in the ED and catheterization lab and survived without deficit.