Mechanical CPR devices compared to manual CPR during out-of-hospital cardiac arrest and ambulance transport: a systematic review

Abstract

AimsThe aim of this paper was to conduct a systematic review of the published literature to address the question: “In pre-hospital adult cardiac arrest (asystole, pulseless electrical activity, pulseless Ventricular Tachycardia and Ventricular Fibrillation), does the use of mechanical Cardio-Pulmonary Resuscitation (CPR) devices compared to manual CPR during Out-of-Hospital Cardiac Arrest and ambulance transport, improve outcomes (e.g. Quality of CPR, Return Of Spontaneous Circulation, Survival)”.MethodsDatabases including PubMed, Cochrane Library (including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials), Embase, and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included manikin and human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case series and case reports.ResultsOut of 88 articles identified, only 10 studies met the inclusion criteria for further review. Of these 10 articles, 1 was Level of Evidence (LOE) 1, 4 LOE 2, 3 LOE 3, 0 LOE 4, 2 LOE 5. 4 studies evaluated the quality of CPR in terms of compression adequacy while the remaining six studies evaluated on clinical outcomes in terms of return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and Cerebral Performance Categories (CPC). 7 studies were supporting the clinical question, 1 neutral and 2 opposing.ConclusionIn this review, we found insufficient evidence to support or refute the use of mechanical CPR devices in settings of out-of-hospital cardiac arrest and during ambulance transport. While there is some low quality evidence suggesting that mechanical CPR can improve consistency and reduce interruptions in chest compressions, there is no evidence that mechanical CPR devices improve survival, to the contrary they may worsen neurological outcome.

Duration of Resuscitation Efforts and Functional Outcome After Out-of-Hospital Cardiac Arrest

“…However, current resuscitation strategies have been optimized for the last 58 years, since the inception of manual external chest compressions. 27 Observational studies and clinical trials with subsequent guideline updates have refined CPR quality, 28–30 defibrillation timing, 31 and pharmacological intervention, 32–34 but the essence of cardiac arrest resuscitation has not fundamentally changed. A new paradigm may be needed to achieve more than modest improvements in patient outcome.…”

Mechanical CPR in a child: can one size fit all?

“…A systematic review of 10 studies was carried out to compare the efficacy of manual CPR versus mechanical CPR during transport of the patient in different vehicles 7. A study by Stapleton8 demonstrated that mechanical CPR was able to provide compliant compressions in 97% of the transfers compared with 37% when manual CPR was performed.…”

Catheterization laboratory activation during mechanical cardiopulmonary resuscitation: When should we say “No?”

“…Also, two recent systematic reviews comparing mortality outcomes with mechanical CPR versus manual CPR for out‐of‐hospital cardiac arrest have shown no difference in the two groups . The quality of studies included in the meta‐analysis ( n = 868), however, was poor, and there was significant clinical heterogeneity.…”