The Lucas Device – Help is On the Way!

July 31, 2019

A 49 -year-old male with no medical history calls 911 with chest pain and shortness of breath after working out at the gym. His 12-lead EKG demonstrates STEMI and while preparing to transport him he goes into cardiac arrest. His initial rhythm is ventricular fibrillation. He receives high-quality CPR, multiple shocks, Epinephrine, Amiodarone, and despite maximal interventions on scene, ROSC is never obtained. He is transported to the closest SRC and pronounced. I think we would all agree that this patient was too young to die.

Unfortunately, up until recently, after exhausting our existing resources we had nothing else to offer this patient. However, soon LAFD will have new technology that could have potentially saved this man’s life and the other 300 cases of refractory shockable rhythms we treat each year.

Most shockable cardiac arrests are caused by a blocked coronary artery. The only way to definitively treat the cardiac arrest is by opening the artery up via stent placement in a cardiac cath lab. But how do we safely transport these patients from the scene of their cardiac arrest to the cath lab while maintaining high-quality CPR? This is where our new technology, the LUCAS (Lund University Cardiopulmonary Assist System) device, will help us save lives.

The LUCAS device is a mechanical CPR device that can provide uninterrupted chest compressions to the patient, allowing for consistent CPR during transportation of the patient. By providing high-quality CPR throughout transport and during treatment in the cath lab, cerebral and cardiac perfusion is maintained, allowing the best chance for not only survival but also a good neurologic outcome.

Soon, the LUCAS device will be available in select battalions to allow rapid transport of patients in cardiac arrest with refractory shockable rhythms to hospitals that can provide definitive care. With the LUCAS in place, the hospital will place the patient on extracorporeal membrane oxygenation (ECMO), which is an advanced type of heart-lung bypass machine that allows for oxygenation of the vital organs (i.e. the heart and brain). Once the patient is on ECMO, the LUCAS will be removed and the cardiologists can open up the blocked coronary artery by placing a stent and hopefully reverse the cause of the cardiac arrest.

The LUCAS device will be carried by selected EMS Battalion Captains, who will arrive on scene to assist with placement of the device and facilitate transport to the select SRCs that have the capability care for these complex patients. Through this pathway, we hope to not only save lives but match the success of other systems in which 50% of these patients walked out of the hospital neurologically intact and were able to return to their families and jobs.

These patients are “too young to die”, but through your efforts, high-quality CPR, and utilizing the LUCAS in this new clinical pathway, we have the potential to save lives!
Be on the lookout for the departmental bulletin for more information on the LUCAS and training opportunities.

By Tiffany Abramson, MD LAC+USC/LAFD EMS Fellow
Photos compliments of www.medicaldevicedepot.com

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