Cardio pump

[ephi]

Hi,

I'm taking an EMT course in Tel Aviv, Israel right now, and we're now in the CPR chapter. We just learned how to use a cardio pump, which is the standard equipment used in CPR here.
I wanted to search for info on it on the Net, primarily because I was worried about the difficulty in using it - especially on the back.
Most of the information I found was from a few years back, when it seemed that the FDA prohibited its use in the States. So I wanted to know whether that was still the case.
The course instructors here claimed that it is much more effective than manual cardio massage, although they conceded that it's very difficult to perform over time, so I don't exactly understand the cost-benefit ratio (time vs. efficiency, assuming you can keep doing manual for longer).
Sorry for the lengthy post - hope I made myself clear, and that this is the right place to post this.

Thanks!
Ephi

(On a side note, from what I was able to gather the level of my training will be like U.S. EMT-B + IV therapy. This is the basic level here, after that there is an Advanced level and paramedic. In general it would be interesting to get an idea of what EMTs abroad are like )

 

[DT4EMS]

I don't know if it is still "prohibited" but I can tell you I have never seen one in use. I do remember when the AHA was doing research on it years ago, but I never saw what the results were. I have never seen one used in the field.

Plus with story after story surfacing of how well the 30:2 ratio is working now in CPR I don't know if we will ever see a product like that "standard" here.

Congrats on starting your EMT school. Keep us up to date on how you are doing.

Kip

 

[FFEMT1764]

I remember using a thumper about 10 years ago, it was on the rescue truck I was assigned to, and thats where it stayed except for the one time I had no choice but to use it (I was alone, an "I", and the nearest transport unit was 30 minutes out) and it's worked so-so, but it did free up my hands to place the ETT and start my IV.

 

[ephi]

Wait a sec! Wanted to make sure we're talking about the same equipment. By cardio pump I mean the "toilet plunger" like device which is produced by Ambu, which has 2 grip handles, and you stand over the patient's legs bending down to use it.
(This is in response to the reply below - it definitely doesn't free your hands..)
What do you mean by the 30:2 ratio working now? What was done before? In any case what we learned on the pump was also 30:2, same as manual.
As for "school" I wouldn't exactly call it that, more of an evening class - it's a course for volunteers (which make up the main backbone of the EMS services here, there are even volunteer EMT-Ps). But it's really cool, and can't wait to get on an ambulance. Thanks!

 

[DT4EMS]

Wait a sec! Wanted to make sure we're talking about the same equipment. By cardio pump I mean the "toilet plunger" like device which is produced by Ambu, which has 2 grip handles, and you stand over the patient's legs bending down to use it.
(This is in response to the reply below - it definitely doesn't free your hands..)
What do you mean by the 30:2 ratio working now? What was done before? In any case what we learned on the pump was also 30:2, same as manual.
As for "school" I wouldn't exactly call it that, more of an evening class - it's a course for volunteers (which make up the main backbone of the EMS services here, there are even volunteer EMT-Ps). But it's really cool, and can't wait to get on an ambulance. Thanks!

Yes, I was familiar with the "plunger" type product. Not Thumper or the new AutoPulse.
Well since I have been involved with the AHA I have watched CPR go from 4 "stair-step" ventilations to 10:2, to 15:2 and now 30:2 whci seems to be doing much better on the side of the patient.

The plunder theory (from what I recall) was it was supposed to help with drawing blood back into the heart on the recoil. Since I never used one I really can't speak to it's eficacy.

 

[ephi]

Yes, I was familiar with the "plunger" type product. Not Thumper or the new AutoPulse.
Well since I have been involved with the AHA I have watched CPR go from 4 "stair-step" ventilations to 10:2, to 15:2 and now 30:2 whci seems to be doing much better on the side of the patient.

The plunder theory (from what I recall) was it was supposed to help with drawing blood back into the heart on the recoil. Since I never used one I really can't speak to it's eficacy.

Yup, that's exactly the theory that they told us here, and they were willing to swear by it So the bottom line is that you do manual over there?

 

[DT4EMS]

Yup, that's exactly the theory that they told us here, and they were willing to swear by it So the bottom line is that you do manual over there?

Primarily everyone uses manual. There are some services that will apply a mechanical device such as the AutoPulse by Zoll. I have not used one, but I have heard of some success with it.

 

[Jon]

Wait a sec! Wanted to make sure we're talking about the same equipment. By cardio pump I mean the "toilet plunger" like device which is produced by Ambu, which has 2 grip handles, and you stand over the patient's legs bending down to use it.
(This is in response to the reply below - it definitely doesn't free your hands..)
What do you mean by the 30:2 ratio working now? What was done before? In any case what we learned on the pump was also 30:2, same as manual.
As for "school" I wouldn't exactly call it that, more of an evening class - it's a course for volunteers (which make up the main backbone of the EMS services here, there are even volunteer EMT-Ps). But it's really cool, and can't wait to get on an ambulance. Thanks!

Wow. I think there is another push to get the toliet-plunger into use... I remember hearing some talk about it at EMS Today in March, and I think I even saw a demo device (but I'm not sure).

I've seen a Thumper in class... never seen a service that carries one. One of the local EMS agencies is carring an AutoPulse on a Single-Provider ALS Fly Car, so that the medic doesn't get stuck doing CPR... I've not heard if they've had any sucess with it or not.

Finially, welcome to the forum!

 

[jeepmedic]

Welcome. I have used the Thumper (didn't like it but it worked) I have seen the Auto-Pulse Want it for my truck can't afford it though. Still trying to get a grant.

 

[trauma1534]

Welcome. I have used the Thumper (didn't like it but it worked) I have seen the Auto-Pulse Want it for my truck can't afford it though. Still trying to get a grant.

Auto pulse is very impresive!!! But, we don't have it on our trucks yet either. Don't think we will be getting one. Our next agancy over has one for everyone to use.

 

[MMiz]

Wait a sec! Wanted to make sure we're talking about the same equipment. By cardio pump I mean the "toilet plunger" like device which is produced by Ambu, which has 2 grip handles, and you stand over the patient's legs bending down to use it.
(This is in response to the reply below - it definitely doesn't free your hands..)
What do you mean by the 30:2 ratio working now? What was done before? In any case what we learned on the pump was also 30:2, same as manual.
As for "school" I wouldn't exactly call it that, more of an evening class - it's a course for volunteers (which make up the main backbone of the EMS services here, there are even volunteer EMT-Ps). But it's really cool, and can't wait to get on an ambulance. Thanks!

We use the device you refer to, and call it a ResQ Pump. I've never used it on a code, and unfortunately because I'm no longer working for the service, don't know of anyone that has.

I can tell you that from training, it's a pain to keep up with good compressions after about a minute and a half. Our best guys could do a good three minutes. It means that dispatch has to dispatch another unit to the scene so that we can rotate CPR. Rotation the CPR compression person was rarely done prior to the pump, but is now common practice.

Because of the pump, we also call many more in the field. Our protocols would have us work a patient for 30 minutes in the field and then call it or transport.

 

[Ridryder911]

The plunger and Thumper are not the same device. A little history of the device is comical. Several years ago two brothers were together and one of them had an AMI. Not knowing how to do to CPR, the brother went and got the "plunger" out of the bathroom... it appearantly worked and the rest is history. No joke, this came out of JEMS.

I have heard good and bad of AutoPulse. Have they been re-released? The last I read, they were still being invistigated after several strange occurences, here is an excerpt of the article:

...."But after nine months of study, which included 306 patients in the Columbus area, safety monitors alerted researchers: Fewer machine-treated patients were leaving the hospital alive.

"It was just the opposite of what we would anticipate happening," said Dr. Michael Sayre, an emergency physician at Ohio State University Medical Center and leader of the Columbus study.

Sayre and his colleagues shared the results yesterday at the American Heart Association’s annual Scientific Sessions in Dallas.

The study included 1,071 patients; 767 of them were considered the "primary" group because their emergency calls related specifically to heart problems. In that group, 373 were treated manually and 394 with the machines. The study included people from suburban Pittsburgh, Seattle, Vancouver and Calgary.

Four hours after the initial call to 911, a similar number had survived — almost 25 percent of those who got CPR manually and more than 26 percent of the AutoPulse group.

The problem was how many of the 767 left the hospital alive. About 10 percent of those initially treated manually and less than 6 percent of those treated by machine lived to go home.

A spokesman for Zoll, the Massachusetts-based company that sells AutoPulse machines, declined to comment. But a statement issued Friday by Zoll CEO Richard A. Packer said the trial was "disappointing because it was not completed." Packer called the results "inconclusive."

"We now better understand the challenges of such an effort, and we plan further research," he said in the statement.

Sayre said he had hoped that the consistent compressions delivered by the machine would beat people, who are prone to inconsistency and can tire during CPR.

"We really wish it would work," he said, pointing out that CPR rescues only a small percentage of heart patients.

There’s no solid answer why the results came out as they did, but Sayre had some theories. Training might not have been sufficient, he said. Medics watched a video and trained with the $14,000 machines, typically for a couple of hours, Sayre said. The problem with that theory is that outcomes should improve with experience, but the data show no learning curve.

Another possible explanation is that the time emergency responders must spend strapping a person into the machine and a subsequent delay in shocking them with a defibrillator was detrimental, Sayre said.

A more remote possibility is that the machine succeeded in circulating more blood and oxygen but that doing so was somehow harmful, Sayre said.

"There could be something going on that we don’t understand."....

Wonder if they solved the problem?

R/r 911

 

[MMiz]

When we started the ResQ Pod/ResQ Pump trials we were told that typically 5% or so of the people that came into our local Level 1 Trauma Center went home. The combination of these devices supposedly touted a 10% recovery rate.

Prior to their use in the USA, the ResQ Pod/Pumps were really only used in Israel and some European countries. It was my understanding that Israel called it the "Cardio Pump"... hence the response.

Unfortunately I don't know the results of the study or any field stories. I'd love an improvement in CPR though!