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. 2018 Aug 20;8(8):CD007260.
doi: 10.1002/14651858.CD007260.pub4.

Mechanical versus manual chest compressions for cardiac arrest

Peter L Wang  1 , Steven C Brooks
Affiliations

Mechanical versus manual chest compressions for cardiac arrest

Peter L Wang et al. Cochrane Database Syst Rev. .

Abstract

Background: Mechanical chest compression devices have been proposed to improve the effectiveness of cardiopulmonary resuscitation (CPR).

Objectives: To assess the effectiveness of resuscitation strategies using mechanical chest compressions versus resuscitation strategies using standard manual chest compressions with respect to neurologically intact survival in patients who suffer cardiac arrest.

Search methods: On 19 August 2017 we searched the Cochrane Central Register of Controlled Studies (CENTRAL), MEDLINE, Embase, Science Citation Index-Expanded (SCI-EXPANDED) and Conference Proceedings Citation Index-Science databases. Biotechnology and Bioengineering Abstracts and Science Citation abstracts had been searched up to November 2009 for prior versions of this review. We also searched two clinical trials registries for any ongoing trials not captured by our search of databases containing published works: Clinicaltrials.gov (August 2017) and the World Health Organization International Clinical Trials Registry Platform portal (January 2018). We applied no language restrictions. We contacted experts in the field of mechanical chest compression devices and manufacturers.

Selection criteria: We included randomised controlled trials (RCTs), cluster-RCTs and quasi-randomised studies comparing mechanical chest compressions versus manual chest compressions during CPR for patients with cardiac arrest.

Data collection and analysis: We used standard methodological procedures expected by Cochrane.

Main results: We included five new studies in this update. In total, we included 11 trials in the review, including data from 12,944 adult participants, who suffered either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). We excluded studies explicitly including patients with cardiac arrest caused by trauma, drowning, hypothermia and toxic substances. These conditions are routinely excluded from cardiac arrest intervention studies because they have a different underlying pathophysiology, require a variety of interventions specific to the underlying condition and are known to have a prognosis different from that of cardiac arrest with no obvious cause. The exclusions were meant to reduce heterogeneity in the population while maintaining generalisability to most patients with sudden cardiac death.The overall quality of evidence for the outcomes of included studies was moderate to low due to considerable risk of bias. Three studies (N = 7587) reported on the designated primary outcome of survival to hospital discharge with good neurologic function (defined as a Cerebral Performance Category (CPC) score of one or two), which had moderate quality evidence. One study showed no difference with mechanical chest compressions (risk ratio (RR) 1.07, 95% confidence interval (CI) 0.82 to 1.39), one study demonstrated equivalence (RR 0.79, 95% CI 0.60 to 1.04), and one study demonstrated reduced survival (RR 0.41, CI 0.21 to 0.79). Two other secondary outcomes, survival to hospital admission (N = 7224) and survival to hospital discharge (N = 8067), also had moderate quality level of evidence. No studies reported a difference in survival to hospital admission. For survival to hospital discharge, two studies showed benefit, four studies showed no difference, and one study showed harm associated with mechanical compressions. No studies demonstrated a difference in adverse events or injury patterns between comparison groups but the quality of data was low. Marked clinical and statistical heterogeneity between studies precluded any pooled estimates of effect.

Authors' conclusions: The evidence does not suggest that CPR protocols involving mechanical chest compression devices are superior to conventional therapy involving manual chest compressions only. We conclude on the balance of evidence that mechanical chest compression devices used by trained individuals are a reasonable alternative to manual chest compressions in settings where consistent, high-quality manual chest compressions are not possible or dangerous for the provider (eg, limited rescuers available, prolonged CPR, during hypothermic cardiac arrest, in a moving ambulance, in the angiography suite, during preparation for extracorporeal CPR [ECPR], etc.). Systems choosing to incorporate mechanical chest compression devices should be closely monitored because some data identified in this review suggested harm. Special attention should be paid to minimising time without compressions and delays to defibrillation during device deployment.

PubMed Disclaimer

Conflict of interest statement

Steven Brooks has received salary support from the Heart and Stroke Foundation to study the implementation of public access defibrillation. Dr. Brooks receives funding from the Canadian Institutes of Health Research to conduct research on the PulsePoint mobile app for cardiac arrest. Dr. Brooks has received operating funds from the Heart and Stroke Foundation and the Canadian Institutes of Health Research for various other peer‐reviewed research studies in cardiac arrest. Dr. Brooks is a paid expert witness for the defense in a variety of civil cases involving the non‐use of a defibrillator in a case of out‐of‐hospital cardiac arrest, misdiagnosis of chest pain and misdiagnosis of meningitis.

Peter Wang has no conflicts to report.

Figures

1
1
PRISMA Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Mechanical chest compressions versus manual chest compressions, Outcome 1 Survival to hospital discharge with good neurological function.
1.2
1.2. Analysis
Comparison 1 Mechanical chest compressions versus manual chest compressions, Outcome 2 Survival to hospital discharge.
1.3
1.3. Analysis
Comparison 1 Mechanical chest compressions versus manual chest compressions, Outcome 3 Return of spontaneous circulation.
1.4
1.4. Analysis
Comparison 1 Mechanical chest compressions versus manual chest compressions, Outcome 4 Survival to hospital admission.
1.5
1.5. Analysis
Comparison 1 Mechanical chest compressions versus manual chest compressions, Outcome 5 Sternal or rib fractures.
1.6
1.6. Analysis
Comparison 1 Mechanical chest compressions versus manual chest compressions, Outcome 6 Haemothorax or pneumothorax.
1.7
1.7. Analysis
Comparison 1 Mechanical chest compressions versus manual chest compressions, Outcome 7 Internal abdominal organ injury.
See this image and copyright information in PMC

Update of

References

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References to ongoing studies

CTRI/2013/07/003840 {unpublished data only}
    1. CTRI/2013/07/003840. Randomised comparison of chest compression using the device AutoPulse® with manual chest compressions in patients requiring Cardiopulmonary Resuscitation (CPR) for in hospital cardiac arrest. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=6068&EncH... (first received 25 July 2013).
ISRCTN38139840 {unpublished data only}
    1. ISRCTN38139840. Mechanical and manual chest compressions for resuscitation in in‐hospital cardiac arrest. https://doi.org/10.1186/ISRCTN38139840 (first received 1 September 2017).
ISRCTN78354073 {unpublished data only}
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NCT01521208 {published data only}
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References to other published versions of this review

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