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Objectives• Explain the emphasis on effective CPR• Understand the importance of Coronary PerfusionPressure (CPP)• Define the characteristics of effective CPRaccording to Guidelines• Describe the effects of rescuer fatigue on chestcompressions900 048-00 RevA Orientation Guide4

ObjectivesReview the use of LUCAS including:• Unpacking and connectingthe air source• Assembly• Adjustment• Operation• Stabilization strap• Defibrillation• Ventilation• Transporting the patient• Changing air source• Removing from patient900 048-00 RevA Orientation Guide5

Sudden Cardiac Arrest (SCA)Treatment Options• CPR• Defibrillation• Oxygenation with ventilation900 048-00 RevA Orientation Guide6

CPR Guidelines have been changed tomake CPR more effectiveWhy is CPR so important?900 048-00 RevA Orientation Guide7

Coronary Perfusion Pressure (CPP)• Measure of pressure driving blood flow to theheart muscle• Typically 60 mmHg• CPP drops dramatically in cardiac arrest900 048-00 RevA Orientation Guide8

CPR• Provides blood and oxygen tothe brain and heart• Generates CPP• CPP ≥ 15 mmHg associatedwith return of spontaneouscirculation (ROSC)Paradis NA, Gerard B, Rivers EP. et al. Coronary perfusion pressure and the return of spontaneous circulation in humancardiopulmonary resuscitation. JAMA. 1990;263:1106-1113.900 048-00 RevA Orientation Guide9

Three Phases of Cardiac ArrestElectrical:• 0-3 minutes• Immediate defibrillationMetabolic:• > 10 minutes• ROSC highly unlikelyCirculatory:• 4-10 minutes• CPR: Ability to generateadequate CPP linked to ROSCWeisfeldt ML, Becker LB. Resuscitation After Cardiac Arrest. A 3-phase time-sensitive model. JAMA. 2002;288(23):3035-3038.900 048-00 RevA Orientation Guide10

Rescuer Fatigue• May lead to inadequatecompression rates and depths• Significant fatigue and shallowcompressions are seen after 1minute of CPR 1• Rescuers may deny that fatigueis present for ≥ 5 minutes 21 Ochoa FJ, Ramalle-Gómara E, Lisa V, Saralegui I. The effect of rescuer fatigue on the quality of chest compressions.Resuscitation. 1998;37:149-52.2 Hightower D, Thomas S, Stone C, Dunn K, March J. Decay in quality of closed-chest compressions over time. Annals ofEmergency Medicine. 1995;26:300-303.900 048-00 RevA Orientation Guide11

CPR Recommendations• Ratio: 30 compressions to 2 ventilations• Rate: 100 compressions/minute minimum• Depth: 1 ½ -2 inches (4-5 cm)• Duty cycle: 50%• Allow chest wall to recoil completely• Minimize interruptions2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation2005;112(suppl IV):IV-25900 048-00 RevA Orientation Guide12

Guiding Principle• The Guidelines and several studies have stressed the importanceof minimizing interruptions in chest compressions• Guidelines recommend switching rescuers performingcompressions every 2 minutes• One study demonstrated it took about 90 seconds after a pausein compressions to re-establish previous CPP levels• Mechanical chest compressors eliminate unnecessaryinterruptions to compressionsSteen S, Liao Q, Pierre L, Paskevicius A, Sjöberg T. The critical importance of minimal delay between chest compressions andsubsequent defibrillation: a haemodynamic explanation. Resuscitation. 2003;58:249-258.900 048-00 RevA Orientation Guide13

Bottom Line• Heart and brain perfusion is critical• The Guidelines changed to make CPRmore effective• Most rescuers have difficulty meetingand maintaining CPR according tothe Guidelines• Looking for new solutions to improve CPR900 048-00 RevA Orientation Guide14

LUCAS• LUCAS is a portable device used toprovide external cardiac compressions• LUCAS meets all of the recommendedGuidelines for effective CPR and won’tget tired!• LUCAS can be used during transport• LUCAS is easy to use and a great assetto the team900 048-00 RevA Orientation Guide15

LUCAS Chest Compression System900 048-00 RevA Orientation Guide16

Uses• Adult patients in acute circulatory arrest• loss of consciousness• absence of spontaneous breathing and pulse• LUCAS should only be use in cases wheremanual chest compression would be used• Intended only for temporary use900 048-00 RevA Orientation Guide17

Contraindications• Too small adult patient• Too large patient• Children• Traumatic injury• Advanced pregnancy900 048-00 RevA Orientation Guide18

LUCAS Cardiac Compression SystemKnob positions:• ADJUST (1)• LOCK (2)• ACTIVE (3)900 048-00 RevA Orientation Guide19

Basic Steps for Use• Arrive at patient and checkresponsiveness• Unpack LUCAS andconnect the air• Assembly• Adjustment• Operation• Stabilization strap• Defibrillation• Ventilation• Transporting the patient• Changing air source• Removing from patient900 048-00 RevA Orientation Guide20

Arrival at the patient• Confirm cardiac arrest• Begin manual CPR untilLUCAS is ready900 048-00 RevA Orientation Guide21

Unpacking LUCAS• Place bag on ground with the top ofLUCAS closest to you• Open cover so that entire bag unfolds900 048-00 RevA Orientation Guide22

Connecting the Air• Confirm knob is in the ADJUST position• Attach air hose connector to regulator ofair cylinder or to wall outlet• Open air valve, if using a pressureregulator• Always follow proper sequence of airconnection and assembly so the devicedoesn’t start compressing by mistakeand potentially cause injury900 048-00 RevA Orientation Guide23

Assembly• Remove back plate from bag• Stop manual CPR• Lift up patient’s upper body• Lay back plate under bodybelow armpits• Resume manual CPR900 048-00 RevA Orientation Guide24

Assembly• Lift upper part out of bag• Open support legs• Pull release rings to ensure clawlocks are opened900 048-00 RevA Orientation Guide25

Assembly• Stop manual compressions• Place upper part over patient’s chestso claw locks engage with back plate• Lock support legs to back plate• Pull up to ensure legs are locked toback plate900 048-00 RevA Orientation Guide26

Adjustment-PositionFor effective compressions and to avoidserious patient injury it's important tomake sure to start with the suction cupin the correct position:• Lower edge of suction cupshould be immediately abovethe end of the sternum• Suction cup should be centeredover the sternum900 048-00 RevA Orientation Guide27

Adjustment Procedure• If the suction cup is too low on thesternum, reposition LUCAS bypulling it up higher on the chest• Compress in the right spot to avoidserious patient injury and geteffective compressions900 048-00 RevA Orientation Guide28

Adjustment Procedure• Ensure the knob is in theADJUST position• Lower suction cup until pressurepad inside suction cup touchespatient’s chest900 048-00 RevA Orientation Guide29

Adjustment Procedure• Do not use LUCAS if:• pressure pad doesn’t touch chest• upper part won’t fit around patient orclaw locks won’t fasten to back plate• Continue with manual compressions900 048-00 RevA Orientation Guide30

Adjustment Procedure• Critical to make necessary adjustments rapidly to minimize “noflow” time or time without compressions• After the back plate is placed under the patient, it should take lessthan 20 seconds to stop manual compressions, connect the upperpart of LUCAS, and start mechanical compressions• “Practice makes perfect”900 048-00 RevA Orientation Guide31

Operation• Turn knob to ACTIVE to begincompressions• Check for proper position• Turn knob to ADJUST toreposition, if needed, and back toACTIVE to resume compressions• Turn knob to LOCK to stopcompressions for any reasons• Do not leave patient or deviceunattended while LUCAS is active900 048-00 RevA Orientation Guide32

Stabilization Strap• Start compressions• Place support cushion under patient’s neck• Fasten cushion straps to device straps• Tighten the straps• Delay, or don’t use stabilization strapwhen it might impair treatment900 048-00 RevA Orientation Guide33

Defibrillation• Defibrillation pads may be appliedbefore or after LUCAS is placed• Make sure pads or wires are notunder suction cup900 048-00 RevA Orientation Guide34

Defibrillation• Stop LUCAS during ECG rhythmcheck or analysis – compressionscan interfere with ECG analysis• Perform defibrillation as usualaccording to the manufacturer’sinstructions following AED promptsand agency protocols• Check for correct position of LUCASon patient’s chest after defibrillationshock and adjust if needed900 048-00 RevA Orientation Guide35

Ventilation• Unprotected airway• stop LUCAS while deliveringbreaths according to the Guidelines• Protected airway• deliver breaths independently ofLUCAS operation according tothe Guidelines900 048-00 RevA Orientation Guide36

Transporting the Patient• Secure the patient’s arms• Apply straps on LUCAS topatient arms• Do not over-tighten• Do not lift LUCAS by thearm straps900 048-00 RevA Orientation Guide37

Transporting the Patient• Lifting the patient• One person on each sideand one person supportingthe patient’s head, even withstabilization strap in place• Those at patient’s side lift withone hand beneath claw locks ofback plate keeping fingers clearof claw locks• Other hand lifts patient’s leg900 048-00 RevA Orientation Guide38

Transporting the Patient• Turn knob to LOCK to pausecompressions during lift• Check position of suction cup• Turn knob to ACTIVE toresume compressions900 048-00 RevA Orientation Guide39

Transporting the PatientOnce the patient is placed onthe stretcher or other surface,LUCAS may be in active stateduring all horizontal lifts andmovements900 048-00 RevA Orientation Guide40

Changing Air Source During Use• Set knob to ADJUST• Close valve on used air cylinder• Disconnect air hose from air source• Attach air hose to new air source• Open valve on new air cylinder• Adjust the height of suction cup, if needed• Turn knob to LOCK• Turn knob to ACTIVE to continuecompressions900 048-00 RevA Orientation Guide41

Removing LUCAS from Patient• Turn knob to ADJUST• Raise suction cup to uppermost position• Close air valve and disconnect air hose from air source• Remove patient arms from support straps• Disconnect and remove stabilization strap• Disconnect upper part of LUCAS from back plate• Remove back plate900 048-00 RevA Orientation Guide42

Side Effects• Bruising and soreness of the chest is common duringuse of LUCAS• The International Liaison Committee on Resuscitation(ILCOR) states the following side effects of CPR:• Rib fractures and other injuries are common but acceptableconsequences of CPR given the alternative of death fromcardiac arrest• After the resuscitation, all patients should be reassessed andreevaluated for resuscitation-related injuries2005 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science withTreatment Recommendations. Circulation. 2005;112(suppl III):III-11.900 048-00 RevA Orientation Guide43

Summary• CPR is receiving renewed attention• More emphasis on meeting Guideline recommendations for CPR• LUCAS achieves effective and consistent compressions easily• LUCAS helps minimize unnecessary interruptions to compressions• Practicing LUCAS application will be benefit both rescuer and patient900 048-00 RevA Orientation Guide44

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