LUCAS device

The Lund University Cardiopulmonary Assist System (LUCAS) device provides mechanical chest compressions to patients in cardiac arrest. It is mostly used in emergency medicine as an alternative to manual CPR because it provides consistent compressions at a fixed rate through difficult transport conditions and eliminates the physical strain on the person performing CPR.[1][2][3][4] The first generation of the LUCAS device (released in 2003) was pneumatic, while the second and third generations are battery-operated.[2]

Lucas device demonstrated on model

Development

After watching paramedics struggling to perform manual CPR on a patient while in the back of a speeding ambulance, Norwegian inventor Willy Vistung came up with the idea for a pneumatic system that could provide automatic, mechanical chest compressions.[2] Cardiothoracic surgeon Stig Steen supported Vistung's idea, and after Vistung's death, Swedish entrepreneur Lars Sunnanväder and Steen developed the final prototype.[2] Steen and his research team did studies at Lund University Hospital, and in 2000, Steen began using it clinically.[2]

In 2003, Swedish ambulances began using the first generation of the LUCAS device, which was driven pneumatically.[2] In 2009, the second generation LUCAS, now battery-operated, was released worldwide.[2][5] In 2016, the most recent generation, LUCAS 3, became commercially available.[2]

Use

The LUCAS device can be used both in and out of the hospital setting.[6][7] The 2015 European Resuscitation Council Guidelines for Resuscitation does not recommend using mechanical chest compression on a routine basis, but are good alternative for situations where it may be difficult or to maintain continuous high-quality compressions, or when it may be too strenuous on the medic to do so.[8]

To place the device on the patient, the medic first places the back plate under the patient.[6] This eliminates the "mattress effect" and ensures the device stays in place. Next, the medic attaches the upper part of the device by locking the support legs onto the sides of the back board.[6] Once everything is lined up correctly, the medic can place the suction cup over the patient's chest and turn it on.[6] Finally, the medic will buckle the stabilization strap around the back of the patient's neck and secure their wrists to the device to make transport easier.[6]

The LUCAS can be set to different rates and compression modes depending on what the patient's situation requires.[6]

Effectiveness

When in transport via ground ambulance, even experienced resuscitators can struggle to maintain effective compressions with minimal interruptions.[9] The LUCAS device delivers high-quality compressions at a continuous rate, while up to a third of manual compressions can be incorrect.[9] In 2013, a 68-year-old male made a complete recovery from an out-of-hospital cardiac arrest after 59 minutes of mechanical compressions on a LUCAS machine, and still had a favorable neurological outcome.[10]

Patients who experience an out-of-hospital cardiac arrest do not have a significantly higher chance of return of spontaneous circulation (ROSC) with a LUCAS device (33.3%) versus manual CPR (33.0%).[11] There is not a significant difference in those who survive to hospital admission, either: 22.7% survival rate for the LUCAS group versus 24.3% for the manual group[11]

References
  1. Rehatschek G, Muench M, Schenk I, Dittrich W, Schewe JC, Dirk C, Hering R. Mechanical LUCAS resuscitation is effective, reduces physical workload and improves mental performance of helicopter teams. Minerva Anestesiol. 2016 Apr;82(4):429-37. Epub 2015 Nov 17. PMID 26576860.
  2. Liao, Q. (2011). LUCAS - Lund University Cardiopulmonary Assist System. Department of Cardiothoracic Surgery, Clinical Sciences, Lund University.
  3. Havel C, Schreiber W, Riedmuller E, Haugk M, Richling N, Trimmel H, et al. Quality of closed chest compression in ambulance vehicles, flying helicopters and at the scene. Resuscitation. 2007;73(2):264–70.
  4. Levy, Michael; Yost, Dana; Walker, Robert G.; Scheunemann, Erich; Mendive, Steve R. (2015-07-01). "A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation". Resuscitation. 92: 32–37. doi:10.1016/j.resuscitation.2015.04.005. ISSN 0300-9572. PMID 25913223.
  5. Rubertsson, Sten Update on mechanical cardiopulmonary resuscitation devices, Current Opinion in Critical Care: June 2016 - Volume 22 - Issue 3 - p 225-229
  6. "LUCAS 3 Chest Compression System Instructions for Use" (PDF). LUCAS-CPR. 2021. Retrieved 24 Dec 2021.
  7. Perkins, Gavin D.; Brace, Samantha; Gates, Simon (June 2010). "Mechanical chest-compression devices: current and future roles". Current Opinion in Critical Care. 16 (3): 203–210. doi:10.1097/MCC.0b013e328339cf59. ISSN 1070-5295. PMID 20463463. S2CID 27666635.
  8. Soar, Jasmeet; Nolan, Jerry P.; Böttiger, Bernd W.; Perkins, Gavin D.; Lott, Carsten; Carli, Pierre; Pellis, Tommaso; Sandroni, Claudio; Skrifvars, Markus B.; Smith, Gary B.; Sunde, Kjetil (2015-10-01). "European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support". Resuscitation. European Resuscitation Council Guidelines for Resuscitation 2015. 95: 100–147. doi:10.1016/j.resuscitation.2015.07.016. ISSN 0300-9572. PMID 26477701.
  9. Fox, Julia; Fiechter, René; Gerstl, Peter; Url, Alfons; Wagner, Heinz; Lüscher, Thomas F.; Eriksson, Urs; Wyss, Christophe A. (2013-03-01). "Mechanical versus manual chest compression CPR under ground ambulance transport conditions". Acute Cardiac Care. 15 (1): 1–6. doi:10.3109/17482941.2012.735675. ISSN 1748-2941. PMID 23425006. S2CID 39512386.
  10. Zimmermann, Stefan; Rohde, Doris; Marwan, Mohamed; Ludwig, Josef; Achenbach, Stephan (2014-01-01). "Complete recovery after out-of-hospital cardiac arrest with prolonged (59 min) mechanical cardiopulmonary resuscitation, mild therapeutic hypothermia and complex percutaneous coronary intervention for ST-elevation myocardial infarction". Heart & Lung: The Journal of Cardiopulmonary and Acute Care. 43 (1): 62–65. doi:10.1016/j.hrtlng.2013.10.011. ISSN 0147-9563. PMID 24238746.
  11. Liu, Mao; Shuai, Zhuang; Ai, Jiao; Tang, Kai; Liu, Hui; Zheng, Jiankang; Gou, Junqi; Lv, Zhan (2019-11-01). "Mechanical chest compression with LUCAS device does not improve clinical outcome in out-of-hospital cardiac arrest patients". Medicine. 98 (44): e17550. doi:10.1097/MD.0000000000017550. ISSN 0025-7974. PMC 6946388. PMID 31689757.
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