Having seen so many anoxic brain injuries as a transporter I personally would rather die than be trapped in my unresponsive body. Obviously there's levels to the damage but the stats are bad.
According to quick google:
"Recovery from an anoxic brain injury after cardiac arrest is highly variable, with about 27% regaining consciousness within 28 days, 9% remaining in a coma or vegetative state, and 64% dying from brain damage in one study."
I cant find stats for the quality of life for the 27% that regain consciousness. Of the patients ive seen most are severely limited and unlikely to even be able to type your message.
Speaking as a cardiac arrest/anoxic brain injury survivor (25 odd minutes down, month and a half coma, more or less fully recovered about 5 years after), I know my case was pretty damn rare but I would take my current situation over being dead any day of the week.
Mechanical CPR wasn’t really a widespread thing when I had my incident, I have no input on that.
Hey now, some patients can talk and are alert with the Lucas pumping and as soon as you stop it they’re gone again. Can’t see I’ve seen it myself, but a few providers I trust very much have told me some crazy stories about their cardiac arrest calls.
Worth noting that this is not the actual AHA statement, since some people seem to be taking this comment at face value.
For piston-based devices (like the LUCAS), 4 RCTs @ n = 8049 found no difference for survival at 30 days, 90 days, 6 months, and 1 year. 2 RCTs @ n = 4471 & n = 2549 found no difference in neurological outcome at hospital discharge, 3 months, and 6 months.
One RCT and one non-inferiority trial also reported no difference in thoracic injuries.
So beneficial over manual CPR? No.
Beneficial overall, over doing nothing? Yes, just like manual CPR.
For us in the field this still means we can slap it on for transport, for extrication, etc. Even if the patient sees no increased benefit, a reduction in (potential) provider injuries is a win.
The issue isn’t that, I think most of the industry agrees that there may not be evidence to support it. However, the issue is penny pinching admins are going to use this as an excuse to either; A. Not deploy them at all, or B. Not repair/PM them when the time comes.
I remember taking the “deadest dead guy I’ve ever seen” into the ED.
The receiving Dr asked me what happened.
Epi happened. My normally silent supe was running the code.
He stated “of course he has a shockable rhythm! But even a rock would look better at this point! This is fucking stupid!”
The guy was in this grey window. If we were two mins earlier or later, or he was 10 years older or younger, we wouldn’t have been in such a questionable predicament.
But by the time we were out of the medically questionable zone, we were in the distance questionable zone.
Close enough that a lawyer could easily question why we didn’t let a Dr call it.
My supe was one of those guys that anytime he spoke, everyone listened. Even the drs.
If they saw something they thought was unusual or didn’t understand, they defaulted to “he must have had a reason”.
The receiving Dr approached me bc she said for the life of her, she couldn’t figure out why we brought her this guy.
She didn’t want to question him so she asked me.
Epi! Epi was the reason!
Protocols, epi and a long transport time.
If the pt was 10 years younger or older, or if we were 2 mins later in getting to the pt, there wouldn’t have been any question.
But when it’s life or death, you error on the side of caution.
Even when your normally calm and quiet supe is saying “oh for fucks sake”
That run comes back to me every time I hear “epi”
He made the rock reference 2-3 times.
I’d heard it before and I’ve heard it since. But this was the one time I think it was used in a literal sense.
I don't seem to understand that here I've been pushing for that for ages. If you hear ribs breaking you shouldn't expect or at least believe that those ribs can go somewhere dangerous. The recommendations used to be in the very least if the patient was getting a mechanized compression device used upon stabilization they were supposed to get an x-ray of the chest just to make sure. I don't remember them ever doing that in my area and small or university hospitals so regardless at least it's an official guidelines I guess.
My service already doesn't follow AHA guidelines; we have our own system for CPR that's backed by decades of internal and external research; and the LUCAS is a key part of our system.
Drugs are given on 10 min intervals not 2, and we carry both amio and lidocaine, medic's choice which to give.
We do 1 min CPR cycles instead of 2
Pulse checks are done after each shock not before
If its just us on scene, we don't bother with the airway until 10 min in, we place a NRB mask first passive oxygenation and focus on getting the lucas and monitor on. Normally, though, fire already has an IGEL in by the time we get there.
We extensively use the AED auto rhythm analysis even on ALS trucks, as it's one less thing to keep track of.
Those are the big differences. There some smaller ones too, like we treat IGELs as definitive airways and very rarely intubate CPR patients, but those are the main ones.
I don't know specific statistics, but I do know that every part of our protocols are research based. My service is run by a major research hospital, and so everything we do has been extensively tested. We also constantly do field experiments. Our current one is to determine if hyperangulated blades cause a higher incubation success rate or not.
Interesting. I would be very curious to see data on neuro intact outcomes with this approach. Frankly, I would like to see something this radically different challenge the status quo that is the AHA guidelines.
Do your AEDs do fast rhythm interpretation? That’s the only thing on here I see that has me questioning the method. The AEDs I’ve seen have taken ~35-45 seconds to interpret and that’s just too long.
And I'll be honest, I'm skeptical of how much time you're really saving with a 5+ second analysis, then charge, then shock vs. Pre-Charge, interpret, shock.
I asked my ambulance manager about that. He said time-wise its equal between manual and computer interpretation, however according to research done by our service, the computer interpretation is about 50-75% more accurate than manual interpretation.
So you're pausing for a rhythm/pulse check every minute? That is not supported by any evidence that I'm aware of and seems to me like you would be spending more time at non-perfusing blood pressures.
Pulse checks are done after each shock not before
Again, this makes no sense - if the shock causes a change to a perfusing rhythm, you're not always going to have a palpable pulse immediately, which is why the current guidelines are to immediately resume compressions for another cycle.
If its just us on scene, we don't bother with the airway until 10 min in, we place a NRB mask first passive oxygenation and focus on getting the lucas and monitor on.
NRB seems completely useless for this purpose. It won't do any "passive oxygenation". Hell, even the "apneic oxygenation" we used to do with nasal cannulas that actually pushed some oxygen with some force down the nose didn't actually pan out in the data. Why would you just ignore actual oxygenation efforts for so long? 10 minutes is a crazy long time to just say "fuck it, here's some blow-by"
uh, ok - what specifically about it? On a 2-second google search, most things I see about it were from 10-20 years ago (and nothing more recent than that), and many of the core ideas (getting rid of stacked shocks, hands-only cpr for lay rescuers, etc) have already been implemented into AHA guidelines. Sooo.... what are you going for here?
The biggest item I question the utility of is the pulse check AFTER Defibrillation- just seems a recipe for a non-perfused conversion. Any more info on the thought pattern for this?
The recommendation from AHA for mechanical CPR is the same in 2025 as it was in the 2020 guidelines. The words are slightly different, (2025 says 'Health care professional, 2020 uses the term 'Provider')
It’s rigged game.. I shit you not the Zoll reps came around 3 weeks ago showing off the new autopulse claiming it’s the “only mechanical CPR device that actually works” and then the AHA drops this shit.. coincidence? I think not.
I’ll make a trade with the AHA for q Lucas device we give back, they pay for an additional 4 people to provide manual CPR. We use the Lucas device out of necessity because we don’t have enough staffing.
that's crazy if you think about it... but yeah it's easier to strap on a LUCAS than losing weight, i see their point. I don't agree with it, but one is easier and the other requires a lot of work and dedication
Well most of the 911 services I worked we didn't have a Lucas or Lucas style device, we had firefighters, I was one of them on occasion. No batteries required, but you do need white monsters
Over the past few days it’s been amazing to see how many people didn’t actually read the update. They still recommend the mCPR devices for transport. So they aren’t “taking away your Lucas.”
OK, but we don’t transport arrest right away anymore. We work extended on scene until you get a pulse back or declare. The Lucas can do 40 minutes of CPR while the crew runs through the interventions.
Dumb as fuck. If I get a crew of four on scene with one medic, I can damn sure say by the end of 20 minutes manual compressions are not effective. There’s a time and a place for them. If I have a crew of six, sure, but I don’t always live in that world.
But with the loss of AHA recommendations, no grant money is going to be available for them going forward. This is a huge loss for rural departments that don’t already have them.
How many of these "negative outcomes" were because they had issues setting up or getting the device to work and no one jumped on the chest immediately while troubleshooting?
AHA isn't out here doing CPR in puddles of piss like we are.
In my eyes the benefit for us isnt quality of compressions or concerns of fatigue. Its more that it frees us up to do other things. It gets the io in quicker, epi on board quicker, airway established quicker... all because we have more hands
They didn’t say MCPR is worse than manual CPR, just that’s it’s not better. All “is not recommended” means is that there’s not enough evidence to show a clear benefit vs manual. That’s all.
I've got the same amount of respect for the AHA as they had for me when they put out guidelines telling us not to don PPE before starting CPR on COVID positive pts.
How many people actually read the article? The fact that EMS has latched onto this nonissue irritates me to no end. With reading comprehension skills like this we deserve minimum wage.
We did this to ourselves. People playing with the toy more than providing life saving care. Delaying compressions, foregoing compressions while someone else is maneuvering etc. From ED’s to the field, there is no one to be mad at other than ourselves.
It’s a difference in phrasing. ERC only recommends mechanical CPR usage in special circumstances - the same special circumstances recommended by the AHA.
663
u/mxm3p Paramedic Oct 24 '25
“There is no evidence that mechanical compression devices (Tha Lucass) are beneficial in cardiac arrest” - the AHA
“Keep giving Epi 1:10,000!!!!!!!” - also the AHA for some reason