Manual Chest Compressions Superior to Mechanical Alternative for Cardiac Arrest

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Mechanical chest compression devices are not superior to conventional, high-quality manual chest compressions.
Mechanical chest compression devices are not superior to conventional, high-quality manual chest compressions.

Manual chest compression, compared with mechanical chest compression, improves survival and better preserves neurological function in patients who experienced cardiac arrest, according to a recent review published in the Annals of Emergency Medicine.

The review sought to answer the clinical question of whether mechanical chest compression device interventions, compared with high-quality manual chest compression interventions, improve neurologically intact survival of patients experiencing cardiac arrest. 

This study examined the outcome of survival to hospital discharge with good neurologic function (primary outcome) following the use of powered and mechanical chest compression devices compared with manual chest compressions performed by trained medical personnel during in-hospital or out-of-hospital cardiac arrest.

Eleven trials published from 1978 to 2015 were selected for inclusion in the review. The randomized controlled trials (RCTs) involved a total of 12,944 patients. The following data were extracted: outcomes, trials (author/year of publication), number of patients, calculated risk ratios (95% CI) by included trial for primary and dichotomous secondary outcomes, and evidence quality (moderate to low).

Missing or ambiguous data were pursued by contacting the original RCT report authors.

The mean age of the patients included in the RCTs ranged between 45.5 to 71 years. Between 58% to 68% of patients were men. Three RCTs reported survival to hospital discharge with good neurologic function and 2 RCTs found benefit for survival to hospital discharge.

Significant heterogeneity among the articles, a severe limitation, was found regarding the type of mechanical device, patient type, timing of device use, and publication year (I2 ranged from 64% to 75%). 

The authors conclude that the "[c]urrent evidence suggests mechanical chest compression devices likely result in comparable but nonsuperior survival compared with high-quality, consistent manual compressions."

Moving forward, the authors recommended that cost-effectiveness analyses be conducted to determine whether the use of mechanical chest compression devices could offset the costs of paramedic injury during manual chest compressions.

Reference

Long B, April MD. Do mechanical chest compression devices compared with high-quality manual chest compressions improve neurologically intact survival of patients who experience cardiac arrest? [published online October 31, 2018]. Ann Emerg Med. doi:10.1016/j.annemergmed.2018.09.027

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