Efficacy of mechanical against manual method in cardiopulmonary resuscitation for out‑of‑hospital cardiac arrest: A meta‑analysis

Abstract

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of mortality worldwide, with the efficacy of cardiopulmonary resuscitation (CPR) methods playing a crucial role in patient outcomes. The present study aimed to compare the effectiveness of mechanical and manual CPR in OHCA, focusing on three outcomes: Return of spontaneous circulation (ROSC), survival to admission and survival till discharge. A comprehensive meta-analysis was conducted, incorporating 39 studies for ROSC, 28 for survival to admission, and 30 for survival till discharge, totalling 144,430, 130,499 and 162,088 participants, respectively. The quality of evidence was evaluated using the GRADE approach, assessing risk of bias, inconsistency, indirectness, imprecision and publication bias. Statistical analysis included pooled odds ratios (ORs) with 95% confidence intervals (CIs) and sensitivity analyses. For ROSC, the pooled OR was 1.09 (95% CI: 0.92-1.29), demonstrating no significant difference between mechanical and manual CPR. Survival to admission favoured mechanical CPR with a pooled OR of 1.25 (95% CI: 1.09-1.43). No conclusive difference was found for survival till discharge, with a pooled OR of 0.79 (95% CI: 0.61-1.02). Substantial heterogeneity was observed across outcomes. Evidence of potential publication bias was noted, particularly in the survival to admission outcome. The overall quality of evidence was graded as very low, mainly due to high heterogeneity and indirectness of evidence. The study suggests that mechanical CPR may improve short-term outcomes such as survival to admission in patients with OHCA but does not demonstrate a significant long-term survival benefit over manual CPR.

Keywords: cardiopulmonary resuscitation; meta-analysis; out of hospital cardiac arrest.

Figure 1

PRISMA flowchart.

Figure 2

ROSC in Out-of-Hospital Cardiac Arrest: Comparison of Mechanical vs. Manual CPR. This figure presents a forest plot comparing the OR and 95% CI for ROSC among patients receiving mechanical CPR vs. manual CPR. The pooled OR and overall effect size are demonstrated, indicating no significant difference between the two methods. CI, confidence interval; ROSC, return of spontaneous circulation; OR, odds ratio; CPR, cardiopulmonary resuscitation.

Figure 3

Survival to Admission in Out-of-Hospital Cardiac Arrest: Effectiveness of mechanical vs. manual CPR. This figure demonstrates a forest plot of the pooled odds ratio and 95% CI for survival to hospital admission. The analysis demonstrates a significant positive effect of mechanical CPR compared with manual CPR. CPR, cardiopulmonary resuscitation; CI, confidence interval.

Figure 4

Survival till discharge in Out-of-Hospital Cardiac Arrest: Comparative analysis of mechanical vs. manual CPR. This figure illustrates a forest plot comparing the odds ratios and 95% CIs for survival until discharge. The results indicate no conclusive difference between mechanical and manual CPR in long-term survival. CPR, cardiopulmonary resuscitation; CI, confidence interval.