LUCAS 2 Compression Device Medicare EMS Ltd

Objectives Explain in importance of Coronary Perfusion Pressure Visit why quality CPR matters Introduction of the LUCAS 2

Coronary Perfusion Pressure (CPP) The coronary perfusion pressure is the difference between the aortic diastolic pressure and left ventricular end-diastolic pressure (LVEDP) Normal values in normal coronary artery flow (TIMI III) is said to be between 15 – 70mmHg CCP in cardiac arrest has been shown to need to be above 15mmHg for ROSC Every interruption to compressions leads to a drastic fall in CCP that takes time to rebuild

Resus Council Guidance 30 compressions to 2 ventilations Compression rate 100-120 per minute Depth of at least 2inces/5cm Chest must be allowed to fully recoil Minimise interruptions Change every 2 minutes

Quality CPR Ultimately provides blood to the brain and heart Generates Coronary Perfusion Pressure Return of spontaneous circulation is thought to associated with a CPP of 15mmHg or above

Quality CPR Large number of studies have shown that quality CPR is essential to achieve high CPP and successful defibrillation As soon as CPR is stopped the CCP falls dramatically and takes up to 90 seconds to resume – rationale for changing from 15:2 to 30:2 Introduction of mechanical devices may solve this

Fatigue Ideally rotate every cycle/2 minutes Fatigue will lead to poor quality compressions in rate and depth Significant fatigue and shallow compressions have be shown after 1 minute

LUCAS 2 LUCAS2 is a mechanical compression device that has several benefits for the cardiac arrest patient; Increased blood flow to the brain from 40% in normal CPR to 65% Maintaining CCP of 15mmHg Increase ETCO2 Reduction to compressions interruptions Defibrillation during compressions

LUCAS 2 Uses: Contraindications: Adult patient in cardiac arrest Must only be used for chest compressions ie not for external pacing Contraindications: Not possible to safely attach device Patient too small/big

Control Panel On/Off Adjust Pause Active – continuous Active – 30:2 Mute Battery life Alarm indicator

Activating the LUCAS 2 Push the On/Off button for 1 second to start self test The LED (green) light will illuminate when the LUCAS is ready for use

Assembly Remove the back plate Stop CPR and place back plat under patient below the arm pits Start CPR

Assembly Once LUCAS has been removed from its bag pull release rings to ensure claw locks are open Straddle the patient Attach one of the supporting legs to the back plate Stop CPR Attach the second supporting leg to the back plate

Adjustment Ensure the LUCAS in is adjust mode Push the suction cup down with two fingers until the pressure pad is touching the patients chest – ensure no restriction the chest wall Push the Pause button to lock the device in the start position (if the patient is too small for the device the warning alarm will sound resume CPR) It should take no more than 20 second to attach the device to the back plate – get practicing!!!

Activation Check the suction cup is in the correct position. If not: Push the Adjust button again and reposition Push the Active button – either continuous or 30:2 Pressing Pause at any time will stop the device but it will still remember the start position Apply the stabilisation straps – back of the neck the device and the wrists to the device

Defibrillation Defibrillation can be performed whilst the device is active The pads can be applied before or after the device – they should already be on the patient! Ensure no wires or pads are trapped by the device After defibrillation ensure the device is still in the correct position, adjust if necessary The LUCAS need only be stopped for an ECG – the device should not be required if this is required!

Ventilation OP, NP, LMA or igel – operate the device in 30:2 mode Deliver ventilations as per guidelines during the paused phase ET – operate in continuous mode The green LED light will illuminate 8 times per minute to indicate ventilation required

Transporting Remove the patient using available equipment as normal Pause the device when rolling the patient The device can be activated again when removing the patient The device will stay in place even if the patient is tilted on a slight angle

Battery Remove the spare battery Push the Pause button Pull the battery upwards to remove Slot in the new battery Wait until the pause LED light to illuminate Push active to start the compressions again The device will remember the start position for 60 seconds

Cleaning the Device Remove the contaminate suction cup Do not immerse the device in water Clean as per universal precautions Ensure device is dry before repacking Mount new suction cup by pulling over compressor