The effectiveness of mechanical cardiopulmonary resuscitation (CPR) compared to manual compressions in cases of out-of-hospital cardiac arrest (OHCA) has been the subject of extensive research. The consensus from the literature indicates that both techniques have their merits, but the superiority of mechanical CPR devices over manual compression remains contentious.
Several studies demonstrate that mechanical CPR devices, such as the LUCAS or AutoPulse systems, excel in delivering consistent and uninterrupted chest compressions, which is critical in maintaining cerebral and coronary perfusion during resuscitation. Research conducted by Ong et al. found that mechanical CPR resulted in significantly higher rates of return of spontaneous circulation (ROSC) compared to manual CPR, observing ROSC in 34.5% of cases with mechanical devices versus 20.2% in manual cases (Ong et al., 2012). This finding is supported by Westfall et al., who noted that mechanical compression devices improve ROSC by over 1.6 times compared to manual compressions (Westfall et al., 2013).
Nonetheless, a substantial body of evidence questions the overall clinical benefits of mechanical CPR regarding long-term survival and neurological outcomes. Studies have shown that while mechanical devices may achieve a higher ROSC rate, they do not necessarily translate to improved survival to hospital discharge or favorable neurological recovery. For instance, a systematic review by Wang and Brooks highlighted that mechanical CPR does not demonstrate superior effectiveness in improving patient outcomes compared to manual CPR (Wang & Brooks, 2018). Similarly, Li et al. observed that mechanical chest compressions did not significantly improve outcomes compared to manual techniques (Li et al., 2016). But in the studies, it was not apparent whether the medical care and interventions provided were accurate or fully implemented per the International Liaison Committee on Resuscitation recommendations, additionally, there was no indication of whether the devices were placed in a 10 second timeframe, or perhaps took longer to place, thereby affecting outcome.
Moreover, the type of arrest rhythm appears to influence the efficacy of each method. Specifically, Chiang et al. found that mechanical devices were particularly beneficial in scenarios involving non-shockable rhythms, reflecting an enhanced role for these devices in certain clinical contexts (Chiang et al., 2022). However, during scenarios with shockable rhythms, the advantages of mechanical CPR diminished, perhaps due to a significant volume of shockable rhythms resolving on the first or second defibrillation.
Concerns regarding safety and potential complications stemming from mechanical CPR devices have also been noted in the literature. Devices may introduce risks such as rib fractures or pneumothorax, which should be weighed against their possible benefits (Kim et al., 2019). Importantly, studies have revealed adverse neurological outcomes in patients treated with mechanical CPR, raising questions about the overall safety and efficiency of these devices in real-world applications (Couper et al., 2016). Safety questions may also not be clear as to the rate of complications stemming from manual CPR, or the rate of complication due to improper use of the mechanical CPR device.
In conclusion, while mechanical CPR offers distinct advantages, particularly in maintaining compressions during transport or in challenging environments, the prevailing evidence does not establish it as unequivocally more effective than manual CPR across all patient populations and circumstances. Future research is imperative to delineate the contexts in which mechanical CPR may provide robust advantages and to establish protocols that optimize the integration of these devices into standard resuscitation practices, as well as speed of application.
References:
- Chiang, C., Lim, K., Lai, P., Tsai, T., Huang, Y., & Tsai, M. (2022). Comparison between prehospital mechanical cardiopulmonary resuscitation (cpr) devices and manual cpr for out-of-hospital cardiac arrest: a systematic review, meta-analysis, and trial sequential analysis. Journal of Clinical Medicine, 11(5), 1448.
https://doi.org/10.3390/jcm11051448
- Couper, K., Yeung, J., Nicholson, T., Quinn, T., Lall, R., & Perkins, G. (2016). Mechanical chest compression devices at in-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation, 103, 24-31.
https://doi.org/10.1016/j.resuscitation.2016.03.004
- Kim, H., Kim, J., Jang, Y., Kang, G., Kim, W., Choi, H., … & Jun, G. (2019). Comparison of in-hospital use of mechanical chest compression devices for out-of-hospital cardiac arrest patients. Medicine, 98(45), e17881.
https://doi.org/10.1097/md.0000000000017881
- Li, H., Wang, D., Yu, Y., Zhao, X., & Jing, X. (2016). Mechanical versus manual chest compressions for cardiac arrest: a systematic review and meta-analysis. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 24(1).
https://doi.org/10.1186/s13049-016-0202-y
- Ong, M., Mackey, K., Zhang, Z., Tanaka, H., Huei‐Ming, M., Swor, R., … & Shin, S. (2012). Mechanical cpr devices compared to manual cpr during out-of-hospital cardiac arrest and ambulance transport: a systematic review. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 20(1), 39.
https://doi.org/10.1186/1757-7241-20-39
- Wang, P. and Brooks, S. (2018). Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database of Systematic Reviews.
https://doi.org/10.1002/14651858.cd007260.pub4
- Westfall, M., Krantz, S., Mullin, C., & Kaufman, C. (2013). Mechanical versus manual chest compressions in out-of-hospital cardiac arrest. Critical Care Medicine, 41(7), 1782-1789.
https://doi.org/10.1097/ccm.0b013e31828a24e3