Debating Mechanical CPR & Ambulance Specs
This month, contributor Joe Holley, MD, responds to feedback from his article “Consistent Compressions Count! Mechanical CPR is producing resuscitation results beyond expectations,” also by Joseph P. Ornato, MD, FACP, FACC, FACEP and A.J. Heightman, MPA, EMT-P, from the JEMS supplement “EMS State of the Science 2014: Advances in Resuscitation.” Also, JEMS Editor-in-Chief A.J. Heightman, MPA, EMT-P, responds to
JEMS.com readers on ideal ambulance specifications introduced in his October article “New Ambulance Design: My ambulance of the future—today.”
Is Mechanical CPR Proven?
It’s a little irresponsible to run an article like this without mentioning the three trials that have shown no improvement in survival with this technology … When we have data of higher quality, we should be aware of it.
I’m not saying no one should use these devices, and they probably are better if you have to transport a patient with compressions in process (which you probably shouldn’t do unless going to an ECMO center). But to suggest they will produce a dramatic increase in survival is just not true, from the data we have so far.
I work for a fire department that has an EMS contract to provide BLS and ALS mutual aid with the county EMS. I recently went on a call for a traumatic arrest. I hopped in the ambulance with the county medic and we started running the code.
The Lucas would not sit properly on the patient’s chest for some reason and, when it would actually run the waveform from the pads, showed some pretty awful CPR. We had end-tidal carbon monoxide monitoring (EtCO2) on her too and it was also showing poor CPR being performed. When I would do compressions manually the waveform and EtCO2 would improve dramatically.
All in all, I’ve just had generally poor experiences with the machines. Manual, when it’s done right, seems to be the best result in my own experiences.
Author Joe Holley, MD, responds: I believe the data is on the way to see if the better return of spontaneous circulation (ROSC) rates lead to better neurological outcomes. As we gain experience with these devices, we’ll be able to show better-quality data.
But having said that, my system of 40 Lucas devices has shown a dramatic rise in ROSC … more than I’ve seen with any other change we’ve implemented.
I’m still skeptical of the forward-facing seats. Not that they’re safer (I have no doubt about that), but that they will allow sufficient reach for me to appropriately treat my patients.
I would add a fold-out ramp; I saw that in an ambulance in Wales, U.K. They wheeled the patient up the ramp and lowered (power stretcher) the patient down into place. No lifting at all. It’s a major back-saver with very little chance of dropping.
Been on ambulance for 36 years! We have seats in the back of ambulance with no bench. We transport one patient. We’re both a BLS and ALS ambulance; we also do fire runs. We have our AMB all set up. We don’t need any more changes. What we have works great.
Editor-in-Chief A.J. Heightman, MPA, EMT-P, responds: Seat companies like EVS have changed designs to allow for rotation of the seat as well as an adjustable slide track. This allows you to slide, turn, lock and position yourself closer, more conveniently and safer (still belted in) near the patient.
Also, ramps are available, but companies such as Macs Lift Gate offer 24″ x 76″–88″ platforms with 1,000 lb. capacity or a 1,300 bariatric capacity lift gate. Each accommodates a variety of litters and transport devices. They use hydraulic power to lift the ramp and gravity to lower them with a manual backup hand crank.