Zoll AutoPulse

[Spock]

The October issue of JEMS has a short review of the conflicting literature regarding the Autopulse. Page 50-53. It also references the associated literature. My service was one of those that received a very brief training module. We were part of the Aspire study.

Live long and prosper.

Spock

[Oilersfan1]

Thanks you all for the comments.

Cheers :occasion5:

[JakeEMTP]

From what I hear, the autopulse and manual CPR have the same or very very close to the same results for return of spontaneous circulation, -BUT- the 30 day survival rate for patients on whom the autopulse was used is lower. I'll stick with CPR.

So you make your decision without trying it? It is a extra tool, that is all. It is your choice whether to use it or not. We use it and have had success with it. Be careful of literature you read, most of the opinions are slanted one way or the other. You have to decide for yourself, don't take someone else's word for it.

[BushyFromOz]

got nothing to do weather or not thunderchild has used the ZAP

Best evidence says that the ZAP has a lower 30 day survival rate than CPR. Literature is as slanted as any other opinion, BUT it holds far more value in levels of evidence than expert opinion

Thunderchilds decision for CPR is more than valid and we must remember that pre-hospital success is far from patient viability. If its true that the 30 day survival is lower, than it should not matter that it works well for us, it does not work well for them, and thats the bottom line

[Fire947]

I, too, have been researching the AP.

I saw the ASPIRE study that was abruptly halted do to preliminary data showing no increase in 4 hour outcomes and a decrease in hospital discharge rates.

However, since then there are at least 3 other studies that indicate dramatically increased patient outcomes - and still FUBAR....nevermind. Here is an article from JEMS (Oct. 2006) that has more info:

http://www.jems.com/news/240393/

More recent studys show that good manual CPR circulates about 30% (at best) of the volume normally pumped by the heart. The AP approaches 100%. Patients pink up. IVs are easier to start. etc.

I agree that it looks violent and is noisy. Any arrest is traumatic for the spectators. Do you think that a person shoving on the center of someone's chest is less disturbing? What about shocking them? shoving a plastic tube down someone's throat? Drilling a hole in someone's leg and jabbing a needle into their bone? Come on!!

My point is that it is a tool, which works well. Like any tool, it has it's specific purpose. You don't use a sledge hammer to drive a finish nail.

[dean83]

I am researching the AP for my service. We had the ZOLL rep to demo it for us before we do a dept. wide presentation and decide whether the device will be of use to us or not.

The compressions actually looked more effective than violent. The advantage of the AP is that it is a true Load Distributing Band (LDB - as described by the AHA), thus minimizing the amount of force placed centrally on the patient reducing trauma. You can place your hand under the device and it only gets snug, not painful. The AP utilizes the entire thoracic cavity to manually compress the heart.

A service to the north of me purchased 7 and are happy with the results. A different service that I used to work with reported patients went from grey to pink, ETC02 to >35mmhg, systolic pressures > 100mmhg, and with high pressures, actually getting "flash" in the IV Cath.

I am very impressed by the device regardless of the Aspire trial. The ASPIRE trial's negative results were in ONE city (Seattle) and that dept. used different protocols than the other cities. The results from the other trial cities with the aspire study showed increased long term mortality. (not to mention the other trials).

One of the other trials, used on terminally ill patients after they were in arrest for 30minutes, displayed coronary perfusion pressures on the patients with the AP. The AP pressures were scaled beside manual CPR pressures and the AP CPP pressures were 2-3 times greater. ZOLL research states that min CPP for ROSC is 15mmhg, manual cpr with interuptions rarely gets above 15.

The above is only my words, look it up for yourself, and make your own decisions.

[CBEMT]

Any study done on the Autopulse done so far isn't worth the paper it's printed on.

NONE of them have taken into account the fact that as soon as the patient hits the ED, they're taken off the device, but if they still need CPR, it's done by a human.

It would be like testing patient outcomes with Epi 1:10,000 in the field but using Vasopressin in the hospital.

[dean83]

NONE of them have taken into account the fact that as soon as the patient hits the ED, they're taken off the device, but if they still need CPR, it's done by a human.

Were you involved in one of these studys? How do you know that they were not kept on the device until the code was called or that the patient gained ROSC?

[JakeEMTP]

Any study done on the Autopulse done so far isn't worth the paper it's printed on.

NONE of them have taken into account the fact that as soon as the patient hits the ED, they're taken off the device, but if they still need CPR, it's done by a human.

It would be like testing patient outcomes with Epi 1:10,000 in the field but using Vasopressin in the hospital.

I respectively disagree CB. Then whole point of what we do is pre-hospital medicine. If we can get them there providing better compressions via the Auto-Pulse, then we have done our job, as has the device. If better compressions help to get a patient with better perfusion to the trauma bay or Cath Lab, the Auto-Pulse has done what it is supposed to do.

Remember. it is just a tool that provides better compressions than you or I could ever dream of providing. That is the sole purpose of the device.

[BEorP]

Were you involved in one of these studys? How do you know that they were not kept on the device until the code was called or that the patient gained ROSC?

I can't speak to the specific study here, but I believe that it is often common practice that EMS study equipment (e.g. an ITD) use to be discontinued upon arrival at the hospital.