Are the "chest thumpers" new?

TakeTwoAspirin, MSN, RN, APRN · Jul 18, 2011

See them mostly with the trauma patients that come in by air. They don't have the manpower to have someone dedicated to chest compressions, so it frees up the flight nurse/doc/practitioner to be pushing drugs/clearing the airway, etc.

Redneckmedic63 · Jul 18, 2011

They've been around in some form or another since the early 70's. I used them occassionally on the squad back in the 80's, but they were bulky, unreliable, and O2 powered - and sucked thru the tanks fast. The new ones now are much better, reliable, and have been researched. Good tool for pre-hospital in the places where they still transport codes - can't see as very practical for in-hospital use.

The newest one I've seen is a vest that slides over the patient's chest. EMS has nicknamed it "The Geezer Squeezer"! LOL

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jul 18, 2011

I remember them being marketed to EMS under the name "Thumper" in the early 80's. Had no experience with them, but heard they had a reputation as great rib breakers, and were hard to use pre hospital. Seems the were attached to a plate put under the patient, they worked oxygen powered (mental note = fire hazard). If the patient shifted position in the back of the moving ambulance (common), the thumper kept doing compressions where ever it had originally been set. From what I've seen, this position problem has been addressed.

ICU, RN, BSN, B.S. · Jul 18, 2011

Saw a code today and someone brought a "thumper" that was a machine delivering compressions to the patient's chest. Nurses around me said it was the first time they've seen the machine. It was my first code and was pretty brutal. I am wondering if these are new.
Also, I am wondering if seeing a code gets easier. I am still very shaken by it and found the entire ordeal very upsetting. It was an elderly dialysis patient. The patient was in rough shape to begin with and even worse after the code (he was brought back to life). I kept asking myself , "why?"

I've never heard or seen of those. I have never had any of my pts code after almost 3 years of nursing, but I just started in the ICU 2 weeks ago, so I will probably be involved in MANY codes!

I saw 1 code at the hospital I just left---and it was very disturbing to watch. I felt the same way; disturbing.

nyrn5125 · Jul 18, 2011

have not seen it in use but heard about very violent compressions and it doesn't adjust based on size. at my cardiac center we get in line and take turns doing compressions. they say one day we might use a machine. it would be nice to have a machine on those 3 hour ordeals. as for getting used to codes it's tough. we are all human and became nurses because we want to do the best for the patient. obviously you will have some that you knew just needed to leave this life and are in a better place and you rationalize it by remembering they are without suffering anymore, and the ones that you tried your hardest because you knew they were too young to pass on so you take those feelings home with you. In time it gets easier to feel that you did the best you could at that moment

Dalzac, LPN, LVN, RN · Jul 19, 2011

In the early 70's I rode on a mobile coronary care unit and we had one The only time we used it was when we had long transport times I hated them they broke so many ribs and I thought they did more damage. But we didn't have an ambulace service The local morgues ran calls they got by listening to police and fire departments. Our unit was staffed with 2 nurses and an off duty firefighter drove the unit. So were spread pretty thin When we did get ambulances they were mostly load and go and then we had 3 life support units north south and us in the middle. Thank God it isn't like that any more

That Guy, BSN, RN, EMT-B · Jul 19, 2011

Never seen one but sound brutal.

As far as it getting easier, I think it does if you deal with it ok. My first code was when I was 17 and running with my local FD. I was more jaw on the floor interested in what was happening with everything to truly understand what was going on. Now I am on the code team at work and I can always tell when it is someones first code. We call them the wall flowers as they just stand there and watch. I imagine it is exactly how i looked when I first saw one.

~Mi Vida Loca~RN, ASN, RN · Jul 19, 2011

I saw one and saw it used and thought it looked pretty brutal and like the patient was having an exorcism. Apparently they are extremely effective though.

akulahawkRN, ADN, RN, EMT-P · Jul 19, 2011

As usalsfyre says, there's not much evidence that they're any better than manual CPR. IMHO their only real benefit is that they don't tire out. If they're set right and they're giving compressions at the right rate, depth, and location... they do work.

Thumpers have been around for quite a long time. Some work and some do not. None or very few will likely provide the efficiency that a beating heart can.

MunoRN, RN · Jul 19, 2011

This has never been proven. They're expensive, heavy and have shown absoloutely no survival benefit in trials so far. One company's device caused such grevious injuries when applied improperly a clinical trial was halted prior to completion.
Don't buy into the hype. Both the devices currently available have proven to be no better than a Mk1 Mod0 firefighter or ED tech. Ambulances shouldn't be transporting patients with CPR being performed routinely anyway.

I'm not sure "absolutely no survival benefit" is at all accurate. While there are some studies that show no improvement in survival rates, there are many that do, including a 235% improvement in survival to discharge for one device (also an 88% improvement in survival to arrival and 71% improvement in ROSC in the field). The conclusion from that study: "Virtually all the evidence supports the effectiveness of the AutoPulse device in increasing perfusion pressure, ROSC, and long-term survival rates." Ong ME, Ornato J et al., JAMA. 2006;295(22):2629-2637)

Another study; 35% improvement in ROSC - Casner M et al. Prehospital Emergency Care. 2005;9(1):61-67.

Another with a 56% improvement in ROSC and 1 year survival rate 6 times that of the manual CPR group. Swanson M et al., Circulation. 2006;114(18):II-554

I had a patient recently who went into V-fib arrest at home due to a completely blocked proximal LAD. She was shocked into PEA by medics but continued to remain pulseless (spontaneous pulse at least) until after stent placement. Prior to arrival, she received 1hr and 15 minutes of CPR by the LUCAS device, with a sustained BP of 100/50 that whole time. After an hour and 15 minutes of PEA she was still fully alert and following commands, that's not something that can be accomplished consistently with manual CPR and 2 compressors, or 3 or 4 for that matter. She also had minimal damage considering the hour and a half from onset to stent placement with a totally occluded LAD; EF of 50% the day after the event and 60% after 1 month. If one of your family members was in the same situation would you rather manual CPR be used for more than an hour?

usalsfyre · Jul 19, 2011

I'm not sure "absolutely no survival benefit" is at all accurate. While there are some studies that show no improvement in survival rates, there are many that do, including a 235% improvement in survival to discharge for one device (also an 88% improvement in survival to arrival and 71% improvement in ROSC in the field). The conclusion from that study: "Virtually all the evidence supports the effectiveness of the AutoPulse device in increasing perfusion pressure, ROSC, and long-term survival rates." Ong ME, Ornato J et al., JAMA. 2006;295(22):2629-2637)
Another study; 35% improvement in ROSC - Casner M et al. Prehospital Emergency Care. 2005;9(1):61-67.
Another with a 56% improvement in ROSC and 1 year survival rate 6 times that of the manual CPR group. Swanson M et al., Circulation. 2006;114(18):II-554

None of these were randomized, one was retrospective, only Ornato's was of any particular size, pick any number of other issues about the data presented. The ASPIRE trial which was supposed to solve all of these issues and be the proof that mechanical devices were far supperior to humans was halted due to drasticly worse outcomes. The results of the CIRC trial are still pending, but the only thing Zoll has mentioned is the results are "similar" to manual CPR. Remeber the emphasis was NOT on high quality uninterupted compressions is 2003-2005, compressions were still routinely interupted to perform ACLS. So data from around that time isn't really all that applicable to todays situation anyway.

I had a patient recently who went into V-fib arrest at home due to a completely blocked proximal LAD. She was shocked into PEA by medics but continued to remain pulseless (spontaneous pulse at least) until after stent placement. Prior to arrival, she received 1hr and 15 minutes of CPR by the LUCAS device, with a sustained BP of 100/50 that whole time. After an hour and 15 minutes of PEA she was still fully alert and following commands, that's not something that can be accomplished consistently with manual CPR and 2 compressors, or 3 or 4 for that matter. She also had minimal damage considering the hour and a half from onset to stent placement with a totally occluded LAD; EF of 50% the day after the event and 60% after 1 month. If one of your family members was in the same situation would you rather manual CPR be used for more than an hour?

One anecdotal case does not make an argument. Mayo Clinic recently had a discharge to survial after an hour plus of manual CPR. What I want for my family is the best care, whether that be from human hands or a device. Considering the devices have not proven to be defenitively better to anyone other than the marketing department's of Zoll and Physio I can't say I believe spending $15k+ on the device makes any sense to me right now.

MunoRN, RN · Jul 19, 2011

None of these were randomized, one was retrospective, only Ornato's was of any particular size, pick any number of other issues about the data presented. The ASPIRE trial which was supposed to solve all of these issues and be the proof that mechanical devices were far supperior to humans was halted due to drasticly worse outcomes. The results of the CIRC trial are still pending, but the only thing Zoll has mentioned is the results are "similar" to manual CPR. Remeber the emphasis was NOT on high quality uninterupted compressions is 2003-2005, compressions were still routinely interupted to perform ACLS. So data from around that time isn't really all that applicable to todays situation anyway.

There's a big difference between your original assertion that there is "absolutely no benefit" and saying that there have not been any RCT's done. RCT's are great and all but are not the only type of evidence. There's not a single RCT to support the need to wear a parachute when jumping out of a plane, although I don't doubt the safety benefits of jumping out of a plane with a parachute compared to without. Depending on the question a study is trying to answer RCT's may not be most suited type of study. Ornato's "Richmond" study was not the only study of any significant size, Swanson's for instance was 878 subjects, compared to Ornato's 783. I'd take you up on your offer to pick "any number of issues" but you haven't presented any others. The ASPIRE trial is good example of the benefit of multi-center trials. The investigators did find poorer outcomes in the device group, but it was limited to a single study site, which turned out to be because they had changed the protocol at that site and weren't defibrillating until much later and weren't doing any CPR prior to the device being in place and running, based on that it's not really surprising they were seeing worse outcomes. I wouldn't be surprised if the CIRC studies are not that impressive, although so far Zoll's device has shown significant advantages over manual CPR. Circumferential compression devices seem pretty archaic compared to piston devices with dynamic recoil, the PARAMEDIC rct of the LUCAS device will probably be more significant. The protocol has changed somewhat since 2003, although no matter how much better we get at manual CPR, it's sort of irrational to think that we can beat a machine at something where the goal is perfect consistency and absolutely no fatigue, there aren't many things better suited for a machine than CPR.

One anecdotal case does not make an argument. Mayo Clinic recently had a discharge to survial after an hour plus of manual CPR. What I want for my family is the best care, whether that be from human hands or a device. Considering the devices have not proven to be defenitively better to anyone other than the marketing department's of Zoll and Physio I can't say I believe spending $15k+ on the device makes any sense to me right now.

These devices are not rare, so it doesn't appear like it's only Zoll's marketing department that see's some value in them. In terms of healthcare device spending, $15,000 is cheap. My hospital spends $50,000 to $75,000 a year just to replace worn-out dynamaps, which we only use to get BP's. We recently changed our logo and spent $400,000 to change our signs. If a machine prevents or limits neurological damage or myocardial damage on just one patient, the associated treatment costs are well covered by the $15k cost of the machine. If your family member was going to need 75 minutes of CPR, and there's a device there ready to go, would request that they do manual CPR instead?