Physio Control LUCAS 3, Инструкция для инструктора

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LUCAS
®
3 Chest Compression System
Instructor Guidebook
: Q Can the LUCAS device be used on trauma patients?
: A There is no contraindication for trauma. Traumatic injuries can be of varying types and
severities, so the professional rescuer who is treating the individual patient must use
clinical judgment to determine when or when not to provide chest compressions.
The LUCAS device must only be used in cases where chest compressions are likely to
help the patient.
: Q Is it OK to use the LUCAS device if the patient is a woman with breast implants?
: A We do not have any clinical data on how the LUCAS device affects breast implants.
Anecdotally, we have heard of patients surviving long periods of LUCAS CPR with
breast implants intact.
: Q Can we use the LUCAS device on a patient that has had a sternotomy?
: A The 2010 and 2015 AHA Guidelines have published the following recommendations
(these recommendations were not changed in the 2015 Guidelines):
“For patients with cardiac arrest following cardiac surgery, it is reasonable to perform
resternotomy in an appropriately staffed and equipped intensive care unit (Class
IIa, LOE B). Despite rare case reports describing damage to the heart possibly
due to external chest compressions, chest compressions should not be withheld if
emergency resternotomy is not immediately available (Class IIa, LOE C).”
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Taking this information and the LUCAS Instructions for Use into consideration, the
physician or medical director can best determine whether it is appropriate to use the
LUCAS device for patients with cardiac arrest after cardiac surgery.
: Q I’ve heard the LUCAS device provides such good circulation to the brain that
patients can “wake up” while they are still in cardiac arrest. What do we do if
this happens?
: A A potential consequence of high-quality CPR (correct depth, rate, minimum of
interruptions) is increased blood flow to the brain and the heart, which may result in
CPR-induced consciousness in individual patients.
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There have been numerous
anecdotal reports of patients becoming alert while still in cardiac arrest during LUCAS
compressions, only to become unconscious again when the device is paused.
In circumstances such as this, there are no specific LUCAS device recommendations.
You must follow your local protocols and/or medical direction.
The International Liaison Committee on Resuscitation (ILCOR) doesn’t currently have
any recommendations for either pharmaceutical or physical management of CPR-
induced consciousness.
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However, a recently published Dutch guideline for prehospital
cardiac arrest suggested that agitation and/or pain during mechanical CPR can be
treated with 2 µg/kg
1
of fentanyl IV (which can be titrated to 4 µg/kg
1
), and 2.5 mg of
Midazolam IV (which can be titrated to 5 mg).
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