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What is the purpose of manual compressions?
Manual compressions are part of cardiopulmonary resuscitation (CPR) that simulates the heart pumping to maintain blood circulation throughout the body (Liu et al., 2019).

What is the purpose of the LUCAS device?
According to Liu et al. (2019), the Lund University Cardiopulmonary Assist System (LUCAS) device is a portable chest compression device that was created to give efficient compressions while reducing any disadvantages of manual CPR. This device is able to perform consistent compressions based on its settings which guarantee effectiveness. There is less interruption of CPR which has the potential to improve patient outcomes (Liu et al., 2019).

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What is the concern?
The survival rate within 30 days of cardiac arrest is dependent on the quality of the compressions and CPR given. This comes into question whether the LUCAS device provides a higher survival rate within 30 days of cardiac arrest compared to manual compressions.

Who is affected?
Anyone with active cardiac arrest can be affected.  Some contributing factors to cardiac arrest are cigarette smoking, high low-density lipoprotein, type 2 diabetes, elevated adrenaline, obesity, inactivity, and hypertension (Hoffman & Sullivan, 2020). The prevalence of cardiac arrest is higher in people with a family history of heart disease, males, and postmenopausal women (Hoffman & Sullivan, 2020).

How are they affected?
Manual compressions can have multiple causes of interruption. Some examples of interruption are fatigue, switching CPR roles, ambulance movement, stretcher position, rescuer mental and physical strength, and the environment (Liu et al., 2019).

The LUCAS device can also have multiple interruptions of CPR  due to the time it takes to program settings, the time it takes to place the device, and the inability to fit the device onto the patient (Fohle et al., 2021).

Where are they affected?
The performance of compressions can be done anywhere manually and with the LUCAS portable device. They can be done in any public setting, ambulance, or in the hospital.

When are they affected?
The moment compressions are initiated on the cardiac arrest patient can affect the survival rate. Manual compressions should ideally be performed immediately after the event of a cardiac arrest.  However, the variability of compression depth and frequency can influence the effectiveness of the performance. The LUCAS device can be set up to give rescuers time to concentrate on advanced life support options. However, this portable device needs to have the proper settings to provide the appropriate frequency, depth, and rhythm to perform high-quality compressions (Liu et al., 2019).

If compressions and CPR are performed immediately, the survival rate is 63. 6%. If a delay of compressions and CPR were to be performed within 5 minutes, the survival rate is 37.5%. If a 10-minute or greater delay were to occur, the survival rate is 4.5% (Liu et al., 2019).

Why are they affected?
If the rescuer has not had the proper training or has not had much experience in providing CPR, the compressions may not be as consistent and effective.

When using the LUCAS device, if the rescuer is unfamiliar with how to properly place the device and what to do to make the device perform compressions, this can affect the patient's survival rate. The rescuer would need to have the proper training on this device before using it on patients.

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[Outcomes Comparing Manual and LUCAS Use in Cardiac Arrest Patients]. (Fohle et al., 2021). Retrieved from https://doi.org/10.1016/S0735-1097(21)04602-7

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Worse 30-day survival rates?

1. A prospective quantitative study by Karasek et al. (2020) provided data that proves that although the LUCAS device had significantly more conversions from non-shockable to shockable rhythm (20.7% vs. 10.10%; p = 0.04), it was found to have a significantly lower 30-day survival rate compared to the manual compressions/non-LUCAS group (5.07% vs. 16.31% in the non-LUCAS group; p = 0.044) in cardiac arrest patients.

2. Fohle et al. (2021) state the survival to 30 days with non-shockable CPR using manual compressions was 25.2%, compared to the LUCAS at 6.4% in cardiac arrest patients.

No Significance?

1. In a meta-analysis of 4 randomized controlled trials and 2 nonrandomized controlled trials, the outcome was proven to have no significant difference in the 30-day survival rate between the LUCAS (7.5%) and manual compressions (8.5%) with P = .50; OR = 0.92 in cardiac arrest patients (Liu et al., 2019).

2. Chiang et al. (2022) have gathered evidence through a systematic review, meta-analysis, and trial sequential analysis encountering the outcome that there is no significant beneficial difference in survival to discharge in cardiac arrest patients when comparing manual compressions to the LUCAS device (OR = 0.87; 95% CI: 0.87–1.06).

Literature Overview
The variability in the probability of survival within 30 days of manual compressions versus the LUCAS device in cardiac arrest patients displays a further need for consistent significant evidence to provide the best patient survival outcomes. The only consistency found was an increase in survival rate with immediate CPR provided using either manual compressions or a LUCAS device. Overall, my findings for comparing manual compressions versus mechanical compressions on 30-day survival rates are considered inconclusive.

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All nurses must understand how and when to perform compressions in the case of a patient experiencing cardiac arrest. During in-hospital code situations, the care team needs to know their individual roles to reduce any cognitive load amid a code. A randomized control trial evaluating the implementation of designated nurse leaders within 20 adult cardiac arrest simulations found that the teams with a designated nurse leader role had improved time to defibrillator application (23.5 s vs 59 s, p=0.004), faster correction of ineffective compressions (7.5 s vs 14 s, p=0.04), improved compression fraction (91.3 vs 89.9, p=0.048), and shorter time to address reversible causes (107.1 s vs 209.5 s, p=0.002) (Pallas et al., 2021).

As for the LUCAS device, the nurse and team involved in using the device need to have knowledge of the system to provide the best patient outcomes. The advantage of using the device is that it allows for less personnel needed for a coding situation while remaining effective. Other than assisting with typical code roles, nurses can also assist in the use of the LUCAS device, applicating the LUCAS device, and transferring the patient onto the backboard of the LUCAS device. A survey on the use of the LUCAS device showed that 56% of participants strongly agreed on the use of the LUCAS1 reduced the number of individuals needed during a code, 59% strongly agreed it improved the quality of chest compressions, and 59% strongly agreed that it creates a more controlled resuscitation experience (Bhatnagar et al., 2020).

The presence and involvement of the nurse improve compression quality which reflects patient 30-day survival rates.

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Currently, nurses are being educated regarding the importance of taking immediate action with patients going into cardiac arrest. Even in nursing school, professors emphasize the saying "time is muscle." Since there is inconsistent evidence comparing manual compressions with the LUCAS device, hospital staff, including nurses, are still obligated to become familiar with their hospital-designated LUCAS device in the case of patient codes. Both manual compressions and LUCAS devices can be utilized during a code.

Nurse Perspective of Code Simulations
During an informal conversation with a nurse, she told me about their unit holding yearly code simulations in their treatment room. She recalled that she had to take part in this simulation during a busy day shift. She told me she hesitated to answer the alarm since she knew there was not a patient assigned to the room and immediately knew it was a simulation. The charge nurse then told her she was obligated to take part in the scenario.

Reflection of Conversation
Although the scenario is fictional, the hospital keeps track of reaction times and notes the care team's actions. Scenarios like these also test the CPR knowledge of nurses and staff to see if compressions and resuscitation measures will be effective for a real code.

Nurse Knowledge and Performance
A nurse's performance in manual compressions or using the LUCAS device reflects on their knowledge and confidence in their skills that could impact the survival of a cardiac arrest patient. A study conducted by Rajeswaran et al. (2018) aimed to test the CPR knowledge of nurses in three hospitals located in Botswana. The study resulted in the pre-test knowledge average score being 48%, which indicated a lack of knowledge in the majority of Basic Life Support steps resulting in a delay in CPR and inadequate performance of manual compressions (Rajeswaran et al., 2018).

Is this improving or exacerbating the issue?
The current nurse's attitude toward reacting to code simulations and improving skills for an actual code is exacerbating the issue. Perspectives against continuing education with CPR and not taking simulations seriously can impact patient survival rates with utilizing manual compressions and LUCAS devices in cardiac arrest patients.

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The link above provides a pdf instructional booklet on how to use the latest LUCAS system.

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1. Continue Required Certification Training for CPR. The training should involve cardiac arrest simulations and opportunities to use the LUCAS device to limit any delays in use. Further understanding of the proper utilization of the LUCAS device can build confidence for any future scenarios. Organizations have their own preferences regarding whether nurses can take these courses within the facility. It is ideal when providing this training to make them fun for nurses. If this is not getting any employees excited, there needs to be a change to get people engaged. A great tactic to use is providing incentives. The organization can provide hourly pay to nurses when they clock in for CPR training. The organization could also offer a pizza party for the unit with the most certified employees. To catch people's attention, get creative and make it worth their time!

2. Safe Nurse-Patient Ratios & Teamwork. Setting the appropriate ratio of nurses to patients based on unit acuity is critical for the potential of having a patient code. A unit that can come together and work as a team during a code can make a difference in the quality of CPR. If a facility does not have a LUCAS device to rely on for consistent compressions then the team needs to function together to reduce compression fatigue. We are all in this together!

3. Know Hospital Code Protocols & Patient Code Status. As nurses, we need to know our hospital policies and protocols to prevent being held accountable for going against the standardized practice. Nurses need to know when to be involved and how to take action based on organizational protocol. During any cardiac arrest situation outside of the hospital, the responder needs to act quickly and look for any signs the patient is a DNR (bracelet, tattoo). In the hospital, the nurse needs to know the code status of all of their assigned patients to prevent any ethical and legal conflicts. Remember, time is everything when treating a cardiac arrest, so act fast!

4. Community Fundraisers. As an active volunteer within my community, I like to remind nurses how much volunteering in the community makes a difference for locals. Smaller fire and first responder stations and hospitals may lack the finances to afford the LUCAS device. Coming together with any facility to raise money and gain the funds for a device that can support survival rates can ease manpower when having multiple codes. Getting involved in more ways than one can be the change we need to better patient outcomes!

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Barriers & Challenges of Nurse Involvement

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Barriers & Challenges of Nurse Involvement

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Staff Shortage

The shortage of staff is a huge barrier when it comes to code response and performing manual chest compressions. In a cardiac arrest circumstance with fewer personnel, quality CPR is impacted as more tasks have to be done to maintain patient health stability. This also causes some of the nurses on the floor to have limited participation in acting on the code due to dispersed responsibility if it is not their patient or if the nurses are assigned in high nurse-patient ratios.

Code Protocols

Depending on the facility, the code protocols can impact the number of people that respond, as well as, the actions taken to appropriately resuscitate the patient. The protocols are also influenced based on facility resources. Some organizations may not have a LUCAS device and are required to act using traditional CPR. Other organizations may require fewer personnel to respond to codes while utilizing the LUCAS device.

Hospital Finances

Hospital finances affect the amount of staffing, the affordability of CPR equipment, and affording the inclusion of first responders. If the facility does not include competitive pay, there will be a decrease in nurse staffing. The hospital needs to have the finances for basic CPR equipment to provide the appropriate care. The LUCAS device is considered a luxury tool that a lot of organizations may not be able to afford. According to LeNoir (2022), a brand-new LUCAS costs about $17,000, compared to a refurbished LUCAS device costing about $10,000. Although expensive, some organizations may view the LUCAS as an investment to lessen the amount of needed personnel during codes.

Nurse attitudes with Simulations

Nurse perspectives with simulations and training on CPR can impact the knowledge in responding with quality compressions. About 63.1% of pediatric nurses had negative attitudes related to CPR (Hendy et al., 2023). Lacking interest in simulation training negatively impacts compression performance.

LUCAS device Size Inclusivity

Unfortunately, the current LUCAS systems available are only able to fit smaller-framed patients. Staff, including nurses, have suggested further training on placing the LUCAS device on cardiac arrest patients with various body habitus (Bhatnagar et al., 2020). Since the device has enough clearance for certain body frames, nurse involvement in using the device for life-saving measures will be limited.

Do Not Resuscitate (DNR)

Ethically and legally, nurses with any DNR patients are obligated not to perform any life-saving measures including CPR. Look for any bracelets or tattoos that say "DNR" on them or check the patient's electronic health record for their code status.

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Two Curricular Concepts:

1. Evidence-based practice. Having a questioning attitude as a nurse is key to strategizing and bettering care for patients. Searching through credible resources and gaining data to support interventions can change the face of nursing. This topic is a concern that resides in bettering practices that can further patient well-being by using evidence-based knowledge in patient care.

2. Economics. The economy and social economic construct of the vast regions within this country fluctuate in periodic intervals. Such variability translates into variable financial decisions organizations make for acquiring patient care resources. Thus, mechanical compressions with the LUCAS could be seen as less of a priority investment versus implementing manual compressions in a financial aspect. As the American currency value remains elevated, healthcare costs will remain elevated causing an effect on the health of communities.

Leadership Role:
My time spent learning at SCOHS has opened my eyes to all kinds of realms within the nursing profession. Rising to all sorts of challenges, I realize anyone on the unit can be a leader. It takes one voice to make a difference. I love how we are always actively working to seek improvement for our patients, ourselves, our community, and much more. The use of evidence-based practices has continued to advance nursing to help a variety of people. Being aware of outside contributors that impact healthcare, like the economy, makes me notice the need on branching out and actively working to support patients which can progressively benefit the community. Overall, I have seen what makes a great leader through this program and I plan to be a leader with the passion I have for this profession.