Effective: 08-24-20
Supersedes:
High quality, manual chest compressions remain the standard of care for the treatment of cardiac arrest. However, mechanical chest compression devices may be a reasonable alternative to conventional CPR in specific settings where the delivery of high-quality manual compressions may be challenging or dangerous for the provider, such as cases with limited rescuers available, prolonged resuscitations, or performing CPR in a moving ambulance.
Policy: Paramedics are strongly encouraged to utilize the LUCAS-3 Chest Compression system when transporting a patient in cardiac arrest, or other situations in which delivery of sustained, high-quality manual compressions is not possible.
Indications:
The LUCAS device may be used in patients 12 years of age and older who have suffered cardiac arrest, where manual CPR would otherwise be used.
Contraindications:
1. Patient less than 12 years of age.
2. Patients who do not fit within the device
2.1. Patients that are too small and with whom you cannot pull the pressure pad down to touch the sternum. The device alerts with three fast signals when lowering the suction cup and you cannot enter the pause mode or active mode.
2.2. Patients who are too large and you cannot lock the upper part of the LUCAS device to the back plate without compressing the patient’s chest, or you cannot press the pressure pad down 2 inches
3. Do not use if it is not possible to position LUCAS safely or correctly on the patient’s chest.
Procedure:
1. Continue all therapies related to the management of cardiopulmonary arrest in accordance with Statewide Treatment protocols.
2. Recognizing the goal of immediate uninterrupted chest compressions, consider delaying application of mechanical CPR devices until after the first four cycles (8 minutes). If the LUCAS Device is applied during the first four cycles, the goal is to limit interruptions in chest compression to 10 seconds or less.
3. LUCAS should only be deployed by providers who have received proper training on the device. A trained provider should accompany any patient the device is being used on for the duration of transport.
4. Upon arrival at the hospital, the LUCAS device should be left in place and active until the receiving ED staff advises otherwise. The LUCAS trained EMS provider should provide assistance and/or guidance (as needed) in deactivating and removing the LUCAS device.
Device Application
1. Activate the LUCAS by pushing the ON/OFF button for 1 second to start the self-test and power up the LUCAS.
2. Pause manual CPR and carefully put the back plate under the patient, below the armpits.
3. Attach the LUCAS to the back plate by pulling the release rings once; then let go of the release rings. Listen for the click when attaching to the back plate and then pull up once to ensure attachment.
4. Center the suction cup over the chest. The lower edge of the suction cup should be immediately above the end of the sternum.
5. Push down the suction cup (with two fingers, making sure it is in the ADJUST mode) until the pad is touching the patient’s chest. If the pad does not touch or fit properly, continue manual compressions.
6. Push PAUSE to lock start position. Start LUCAS compressions by pushing ACTIVE button (play symbol) in either continuous mode or 30:2 mode.
7. Attach the LUCAS stabilization strap.
Defibrillation
1. Defibrillation can be performed with the LUCAS device in place and in operation.
2. The defibrillation pads and wires should not be underneath the suction cup.
3. If the electrodes are already in an incorrect position when the LUCAS is placed, you must apply new electrodes
4. If the rhythm strip cannot be assessed during compressions, one may stop the compressions for analysis by pushing the PAUSE BUTTON (The duration of interruption of compressions should be kept as short as possible and should not be > 10 seconds. There is no need to interrupt chest compressions other than to analyze the rhythm).
5. Once the rhythm is determined to require defibrillation, the appropriate ACTIVE BUTTON should be pushed to resume compressions while the defibrillator is charging and then the defibrillator should be discharged.
Pulse Checks/Return of Spontaneous Circulation (ROSC)
1. Pulse checks should occur intermittently while compressions are occurring
2. If the patient moves or is obviously responsive, the LUCAS Device should be paused and the patient evaluated.
3. If there is a change in rhythm, but no obvious indication of responsiveness or ROSC, a pulse check while compressions are occurring should be undertaken. If the palpated pulse is asynchronous, one may consider pausing the LUCAS Device. If the pulse remains, reassess the patient. If the pulse disappears, one should immediately restart the LUCAS Device.
Disruption or Malfunction of the LUCAS device
If disruption or malfunction of the LUCAS device occurs, immediately revert to manual CPR.
Care of the LUCAS device after use
· Remove and replace the suction cup.
· If necessary, remove and clean the patient straps and the stabilization strap.
· Clean all surfaces and straps with a cloth and warm water with an appropriate cleaning agent.
· Let the device and parts air dry.
· Replace the used battery with a fully-charged battery.
· Repack the device into the carrying bag.
· Make sure that the charging cord is plugged into the LUCAS device.
· The battery should be changed after each use.
References:
Massachusetts Statewide Treatment Protocol 1.1
AHA Guidelines (page 15) https://eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf
AHA Consensus Statement (page 424) https://cpr.heart.org/-/media/cpr-files/resus-science/high-quality-cpr/cpr-statement.pdf?la=en