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EMS agency implements new CPR procedures

Chief Shane Lockard said the district is among the first in the U.S. to adopt a new combination, the ResQCPR System and the Lucas 3 chest compression system


By Sue Sterling
The Daily Star-Journal

WARRENSBURG, Mo. — The Johnson County Ambulance District has implemented new cardiac arrest procedures designed to improve survival rates for patients experiencing out-of-hospital, non-traumatic cardiac arrest.

Chief Shane Lockard said the district is among the first in the United States to adopt a new medical device combination, the ResQCPR System from Zoll Medical Corp., and the Lucas 3 chest compression system that provides automatic, continuous chest compressions during transport.

Traditional cardiopulmonary resuscitation used manual chest compressions, Lockard said, but national outcomes have been poor, with less than 10 percent of patients surviving out-of-hospital cardiac arrests, according to the American Heart Association.

The longer it takes emergency personnel to get to the patient, the less likely the patient will survive a cardiac arrest, he said.

“We weren't very happy with the outcomes here,” Lockard said.

After personnel attended several classes and researched CPR devices, he said, they settled on the ResQCPR System and the Lucas 3 system.

The ResQCPR System, approved by the U.S. Food and Drug Administration in March 2016, is the first and only device indicated to improve the likelihood of survival in adults who have experienced non-traumatic sudden cardiac arrest.

The system is composed of a ResQPUMP, a hand-held pumping device with a suction cup that is placed on the chest during CPR to perform active compression-decompression CPR, and the ResQPOD ITD, a respiratory adjunct that returns more blood to the heart and lowers intracranial pressure by regulating airflow during CPR to increase the vacuum in a patient's chest during chest wall recoil.

The suction lifts the chest up, helping pull oxygenated blood into the heart, Lockard said.

Company literature states that a large clinical trial comparing conventional CPR to ResQCPR showed a 49 percent increase in one-year survival in adult patients receiving the ResQCPR treatment.

The Lucas 3 chest compression system provides mechanical, continuous and consistent chest compressions in the ambulance for patients in cardiac arrest, alleviating the risk to paramedics trying to perform CPR in a moving ambulance.

The device can be put on the patient in less than 10 seconds, he said, with no interruption to CPR. The device will continue to provide compression until it is turned off, including during the patient's transfer from the ambulance into the hospital.

“CPR never stops, which is critical,” he said.

The device allows the paramedic to remain seated and seatbelted while chest compressions continue, Lockard said.

The Lucas 3 device is stored in the duty chief's response vehicle and deployed to cardiac arrest incidents.

“Our goal is to increase the survival rate in Johnson County to 25 percent” of patients experiencing non-traumatic cardiac arrest, he said.

According to American Heart Association statistics, in 2015, 326,000 cardiac arrests occurred outside hospitals, resulting in 293,000 deaths.

Twenty-five percent of patients had no symptoms or warning, and 38 percent were witnessed by a bystander. Sixty percent were treated by EMS.

Nationally, the survival rate is 10.6 percent, Lockard said, with an 8.3 percent rate for good neurological outcomes.

In Johnson County in 2016, Lockard said, ambulances responded to 62 cardiac arrests and attempted resuscitation on 42. The other 20 were beyond help, he said.

Of the 42 treated, he said, crews returned circulation to 12, and 28 percent were delivered to the hospital with a pulse.

Lockard said he does not know how many of those survived and went home.

From January through September this year, he said ambulances responded to 59 cardiac arrests and made attempts to resuscitate 32 of the patients.

They managed to get a pulse on eight patients, he said, and 25 percent were delivered to a hospital with a pulse.

Again, he said, there are no statistics on how many of those survived to go home.

The major change, he said, is delivery of high-performance CPR by ambulance crews.

All EMTs and paramedics received 12 to 16 hours of training on the new equipment in November, Lockard said, prior to the new protocol and equipment being put in place on Dec. 1.

Like NASCAR pit crews, every member of the ambulance crew has a function to perform, Lockard said.

The first to arrive starts compression, he said, and a second starts the ventilation.

As others arrive, each takes a new position.

A crew member will perform compression for two minutes before being relieved by a fresh crew member, he said, with the rotation continuing until the patient is moved from the scene.

The person at the head “never leaves,” he said.

Another change, he said, is that all the ResQCPR equipment is contained in a bag and can be easily accessed.

Lockard said data will be kept on outcomes so results can be evaluated.

“In six months, we'll look at the data,” he said, adding, “There may be new research or data” to explore. “It's critical we get accurate documentation on what we do well and what we can improve on.”

In inner cities where the system has been deployed, he said, they are recording a 49 percent survival rate for patients where someone witnessed the cardiac arrest and administered CPR until the ambulance crew arrived with the equipment.

In 2018, he said, JCAD will focus on training the public in compression-only CPR and “stop the bleeding.”

“Without pre-arrival CPR,” he said, “the chance of survival disappears.”

911 dispatchers have received emergency medical training and can provide CPR instruction over the phone, he said.

Lockard said, “We believe these changes in our cardiac arrest procedures, along with the addition of the new CPR systems, will result in a higher potential for positive patient outcomes in cases of sudden cardiac arrest.”

Copyright 2017 The Daily Star-Journal

McClatchy-Tribune News Service

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