How One Florida EMS Agency Uses a LUCAS Device to Improve CPR Outcomes
Venice, Florida’s population is about 28,000, with the average age being around 70 as the area attracts many retirees and snowbirds.
“We tend to have more cardiac calls in our area,” said Steven Lambright, Venice Fire & Rescue assistant fire chief, EMS.
“From what I’ve seen over all of the places I've worked, we have some of the best survival rates through cardiac arrest,” said Donald Morrell, EMS supervisor. “A lot of that has to do with the LUCAS (Lund University Cardiac Assist System). We adopted it because it was so effective. The local helicopter service (Bayflight, operated by Air Methods) uses them, and that’s where we brought them over from. As soon as we got them, we saw positive change. It allowed us to be more effective with the crews we had, and it does CPR better than any human being.”
The agency purchased them in October 2020, with full deployment in 2021.
Shortly afterward, Venice Fire & Rescue used the LUCAS in response to a cardiac arrest call as is described in this 2021 local ABC News segment in which Ned Thompson reunited with first responders who had saved his life.
Thompson had been doing maintenance work with a friend at a condominium complex when he collapsed inside one of the units. His friend called 9-1-1 and initiated CPR. Law enforcement arrived on the scene, taking over CPR until paramedics arrived and used the LUCAS.
Paramedics transported him to the local hospital, where he received two stents during surgery. Thompson expressed amazement, noting he was “gone for 15 minutes” and rescuers brought him back.
Morrell was equally amazed. “I’ve been doing this for 34 years, and I've never had anybody wake up completely,” he said. “It was crazy. We went through the paces, starting in asystole. We were able to get him back a little bit. We did a defibrillation, back to asystole. His end-tidals kept climbing, which is good because the machine’s running at that point—the body's starting to come back. We got him down on the stretcher and got ROSC as we were coming down the stairs. We were able to use this unit the whole way down the stairs.”
The LUCAS units sense the depth of the chest and are designed with plungers that go down and a suction cup for the chest.
“It does a recoil also, so it's going in both directions,” Morrell said. “It’s very easy to use.”
By using automated, guidelines-consistent CPR, the LUCAS device provides consistent and high-quality chest compressions shown by research to increase the chances of positive patient outcomes. Studies show the LUCAS device increases blood flow to the brain and achieves higher EtCO2 values compared to manual compressions. More than 50,000 devices are in the global market.
Venice has a Stryker LUCAS 2 Chest Compression System on all its ALS units and a marine rescue boat. The agency has 70 personnel and three stations, with each having at minimum a rescue and fire engine. One station has a daytime truck with two paramedics for call volume. Another station has a ladder truck.
According to Stryker, its latest LUCAS 3 v3.1 chest compression system measures 22.0 x 20.5 x 9.4 inches when assembled and 22.8 x 13.0 x 10.2 inches in the carrying case. The carrying case includes a window for quick battery checks.
The LUCAS features an external power supply enabling prolonged operation and charging. The device can be charged inside the case through access port. The device with battery (no straps) weighs 17.7 pounds. When using multiple batteries or an external power source, a battery typically lasts for 45 minutes of operation.
It provides a rate of compression of 102 +/- two compressions per minute with a depth of 2.1 inches. There is no patient weight limit. The chest height can be between 6.7 inches to 11.9 inches with a maximum chest width of 17.7 inches. The LUCAS features a low-profile back plate for patient application. The LUCAS device maintains chest compressions during transport to advanced lifesaving therapies, including extracorporeal membrane oxygenation or percutaneous coronary intervention in the cath lab. The LUCAS straps secure patient arms and device during transport.
Only seven seconds of interruption is demonstrated when transitioning from manual to mechanical CPR in clinical use.
The LUCAS can be configured to protocols within guidelines, such as configuring compression rate, depth, and alerts via LIFENET connectivity, which also confirms device or fleet status. The LUCAS also features adjustable ventilation alerts, pause length and count, and a timer to remind rhythm and pulse checks. Users can set auto-lowering and pressure pad parameters to preferences.
Morrell pointed out with cardiac arrest, the most important task is keeping compressions going.
“The medications help. The airway helps, oxygenation helps,” he noted. “The main thing is staying on the chest, keeping the coronary perfusion pressure and cerebral perfusion pressure up to a point where you are avoiding cell death. It’s so good that it has so much pressure that's going in and out of that patient that they can actually wake up and that's beating their heart for them.”
“The LUCAS never gets tired,” said Lambright. “It does the exact rate non-stop. That’s a benefit because it frees up personnel to do other things. Especially now, it’s not very safe to be driving to the hospital while someone's doing compressions because they’re not effective. Having that doing it allows us to be safe from the back, to be buckled in if we need to be driving.”
To access and share post-event data, users can make QI/QA documentation faster and easier with emailed post-event reports. Easy access to LUCAS device data enables productive post-event review. Users can integrate with CODE-STAT data review software.
Lambright noted available data after an event includes the length of time it was used, how many compressions were administered, and how deep it went.
“We can take that data, build on it, and use it for our quality assurance and improvement plans,” he added.
Morrell said Venice field training officers attended the Florida Resuscitation Academy and were able to fine tune how they wanted to use the technology.
“We implemented pit crew CPR which in itself was a good system because everybody has a job to do, like the ER where everyone has assigned roles,” he said, adding the LUCAS device enables two people to tend to other tasks.
“Since you can become manpower short pretty quick with these calls, it allows the person in charge to get out of the fray and manage the call and the patient,” he said. “They're just giving directions to the crews instead of being down there trying to do CPR. They give medications, defibrillations, and do everything they need to do now that they're freed up to do that.”
The average time it takes for Venice Fire-Rescue to transport to the nearest ER is five to seven minutes. Upon arriving to a call, one person begins CPR while the other is preparing the LUCAS. The arms of the device are put onto the patient while the human compressions continue so there is as little break in compressions as possible, noted Morrell. The LUCAS is secured in two minutes or less, he said.
“CPR is very labor intensive as it is,” Lambright said, adding studies show the quality of CPR goes down by 50% after the first two minutes.
“We constantly have to be rotating people in and out,” he said. “That takes more units out of service. They have to assist. That's all eliminated with this machine. There is a small time frame of manual CPR while it's getting set up, but once it's set, the labor intensive portions are over and done with. It allows us to better coordinate with the people we have on scene and use less resources to really do a better job."
Lt. Derek Lowery, a firefighter and EMT, noted the LUCAS is also useful on boat rescues.
“The boat hits waves, you get unstable and you're rocking back and forth. It’s almost next to impossible to do perfect CPR in those conditions,” he said. “The LUCAS mounts on, it’s tight and strapped on; it doesn't miss a beat. The efficiency and the consistency is 100% perfect compared to a human doing it.”
Units cost about $15,000 each, noted Lambright.
“If you go to any EMS chief, they will tell you they would love to have the system,” he added. “A lot of it is just money. If you have 20 stations, you're looking at over $2 million to try to implement this system.”
Lambright said in making the case to decision-makers, while it’s an additional cost initially, “you’re increasing the level of care, there’s better survival for these critical events, and you're utilizing your resources better and more efficiently in not having to bring so many of them in to do this task.”
He added there also are grants to help fund the purchase. Venice Fire-Rescue has factored into its budget the cost of replacing batteries and eventually new units, which Lambright noted will be the latest technology being offered.
Morrell said every crew member at every station trains on the LUCAS once a month. The agency is in talks with the local hospital’s emergency room to supplement it with machines so that if they bring someone in, the machine stays with that person as long as it’s needed, he said. The person in cardiac arrest can go straight to a cath lab to get the necessary care while the LUCAS is giving chest compressions and the first responders can take another machine back to the station.
“Hospitals are short staffed, too,” Lambright said. “They have it a little bit better than us when it comes to staffing and room. But for them to be able to say, ‘OK, turn it on, let it go, and we can do our thing’ is just great. It’s not only EMS; other healthcare providers are noticing that these are pretty good.”
Lambright noted the only challenge in the use of the technology is the "old school, new school" mentality regarding change. Those experienced in doing CPR may believe they’re more than suited to do it without technology, but once they see it in use—especially in challenging situations—they can’t imagine a response without it, he said.
