LUCAS the lifesaver

Television and movies often show scenes where the flick of a switch administers electrical jolts to jump-start a stopped heart. Though still a gripper, the scene is so common it is taken for granted. But the actual survival rate of sudden cardiac arrest patients outside a hospital is only only three to five percent. And even for those in hospitals, successful defibrillation generally needs to be done within three to four minutes.

Why the long odds? There are numerous challenges to survival, but a major factor, says Erik von Schenck, CEO of Jolife AB, is that within a few minutes, a stopped heart starts to swell, up to twice its normal size. Once that happens, it is too large to spark back to its life-giving beat.

For defibrillation to arrive in time for a decent chance of returning a heart to life, cardiopulmonary resuscitation (CPR) is needed to keep swelling minimal and oxygen flowing to the brain and vital organs. Time is the enemy. CPR must be initiated very quickly to avoid permanent brain damage, which can begin to set in after three or four minutes, and it must be properly done. But despite widespread knowledge of CPR, the mortality rate for sudden cardiac arrest (SCA) exceeds ninety percent. According to Lars Wik, M.C, Ph.d, of Ulleval University Hospital in Oslo, Norway, ìsurvival rates have not increased during the last forty-five years.

Enter the LUCAS CPR, a robotic CPR mechanism produced by Jolife (www.lucas-cpr.com). Light (6.5 kg) and portable, powered by an air or oxygen cylinder, it can be easily applied to a heart attack victim in twenty seconds. Activated, it is precise and reliable as it provides the100 chest compressions per minute urged by CPR guidelines, to a depth of 5 cm, at a pressure of 50kg.

Why is this different than what a trained individual can apply? Do CPR on a dummy, or even a pillow, suggests von Schenck, and keep it going for five minutes, aiming for what the guidelines call for. Try it, and the point is readily made. Itís exhausting, even without the stress of a life suddenly depending on you. Even experienced paramedics tend to lose around 60% of their efficiency within three minutes, says von Schenck. The chances of providing 100 chest compressions of approved quality per minute from the beginning, compressing the thorax by 20% of chest height, are almost nil. By the time five minutes have passed, only eighteen compressions per minute meet approved standards.

Moreover, the pressure of 50 kg is often a rib-cracker - a small price for survival but one that many people administering CPR are reluctant to exact.

This does not mean that CPR should not be applied after a call for help, of course it should be. But a LUCAS in the hands of a first responder with already on the site in the hands of someone trained to use it significantly improves the odds of survival. According to von Schenck, of the first 95 patients treated with a LUCAS device, nearly half had the return of spontaneous circulation when arriving at hospital, and when the LUCAS was attached within fifteen minutes, sixteen percent of the patients were alive after a month.

Efficient chest compressions can retain 65% of normal circulation, often sufficient to prevent heart and brain damage. We can improve the quality of CPR, says Lars Wik, by providing mechanical CPR that is consistent, good quality CPR. The machine never tires, and can be used during transportation, achieving the guidelines, all the time, night and day.

Another major advantage of the LUCAS, says von Schenck, is a powerful suction cup that pulls the chest back up with each compression. This could improve the respiratory impact.

There are additional practical impacts obvious to any first responder. LUCAS can be rushed into a home and applied on a bed, floor or stretcher, and then never miss a beat as the patient is loaded into an ambulance. Of critical importance, LUCAS performs flawlessly throughout the journey to hospital, something very difficult for paramedics to safely accomplish on their own. Risks to rescuers are minimized, and once LUCAS is on the job a solitary rescuer is free to administer to other patient needs, like medication, and investigate and attend to other injuries. And the LUCAS has no objections to defibrillation while its working.

Defibrillation is optimized when performed with chest compression, notes von Schenck In-hosptial cardiac arrest has brought the LUCAS into use during PCI-treatment and on patients suffering cardiac arrest caused by hypothermia, intoxication, drowning and anaphylaxis, with resuscitation maintained for long periods.
Use of the LUCAS is rapidly spreading in Europe, including Scandinavia and the UK. It has treated over 3,000 patients. LUCAS has just received 510k clearance from the FDA and we will have a targeted launch to selected customers in the US later this year, says von Shenck. Those seconds that count big in the chain of survival will soon start ticking in America.