Practice Updates

Sophie Karwoska Kligler, MD

Why It Matters

Timely, high-quality CPR remains the cornerstone of out-of-hospital cardiac arrest (OHCA) resuscitation, with strong evidence demonstrating significant improvements in rates of return of spontaneous circulation (ROSC), survival to hospital discharge, and neurologically intact survival. Mechanical CPR devices such as the LUCAS (Lund University Cardiopulmonary Assist System) promise consistent, guideline-compliant compressions while reducing rescuer fatigue and improving provider safety — especially in pre-hospital settings where provider numbers are limited and circumstances often require complex extrication and prolonged transportation. The theoretical physiologic benefits of this intervention are clear — but translation to improved patient-centered outcomes has been less convincing. Despite increasing adoption by EMS systems both within the US and abroad, clinical outcome data remain mixed, raising important questions about when and how mechanical CPR devices should be used. 

Prevalence of mechanical CPR use

U.S. registry data show that mechanical CPR use overall has steadily increased over the past 2 decades,
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EBM is under attack. The Trump administration has signaled it will de-regulate the FDA, lowering the current threshold of safety & efficacy. This may bring us closer to the pharmaceutical disasters of the past: the children of Thalidomide, snake oil salesmen selling heal-all elixirs, Bayer’s invention & marketing of Heroin as a non-addictive cough suppressant, and more. They will argue higher FDA thresholds increase cost, while we know more evidence actually reduces cost – up to $1 Trillion per year1.

And us academics have become lazy. This week a third-year EM resident told me LOC is an absolute indication for a head CT. I pimped him on the Canadian CT Head Rule (CCHR), he seemed confused, looked it up, and then argued “well these tools always miss things so I don’t use them” [many tools do miss a few and yet are still useful, but CCHR essentially does not miss any,
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