Mechanical Chest Compression Devices Versus Manual Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review
Keywords:
Cardiopulmonary resuscitation, mechanical chest compression, out-of-hospital cardiac, Ultrasonography, Emergency Medical Services, Trauma, Triage, Diagnostic Imaging, Patient Outcome Assessment., survivalAbstract
Background: Out-of-hospital cardiac arrest (OHCA) remains a major cause of global mortality, and high-quality chest compressions are critical for survival. Mechanical chest compression devices were developed to standardize compression depth and rate, reduce rescuer fatigue, and enable continuous compressions during transport. However, their routine clinical effectiveness compared with manual cardiopulmonary resuscitation (CPR) remains uncertain across emergency medical systems.
Methods: A systematic review of PubMed and related databases was performed following PRISMA 2020 guidelines. Eligible studies were randomized or comparative cohort designs evaluating mechanical versus manual chest compressions in adult OHCA. Data were extracted independently, and outcomes were summarized narratively without meta-analysis. The primary outcomes were survival to hospital discharge and favourable neurological recovery (Cerebral Performance Category); secondary outcomes included return of spontaneous circulation (ROSC) and CPR process quality.
Results: Eleven studies met inclusion criteria (four randomized trials, seven observational cohorts) encompassing more than 20,000 OHCA patients. Across major randomized trials, survival to discharge did not differ significantly (6-11% mechanical vs 7-11% manual; pooled adjusted odds ratio 1.0, 95% confidence interval 0.8-1.3). Neurologically favourable survival showed no consistent benefit, and some registries reported worse outcomes with device use (adjusted relative risk 0.41-0.70). Secondary outcomes demonstrated improved compression fraction but no improvement in ROSC or 30-day survival.
Conclusions: Routine mechanical CPR did not improve survival or neurological outcomes compared with high-quality manual CPR. Device use should be reserved for contexts where manual compressions are unsafe or impractical, supported by strict training and monitoring.
