A meta-analysis of the resuscitative effects of mechanical and manual chest compression in out-of-hospital cardiac arrest patients

Ni Zhu, Qi Chen, Zhixia Jiang, Futuan Liao, Bujin Kou, Hui Tang, Manhong Zhou, Ni Zhu, Qi Chen, Zhixia Jiang, Futuan Liao, Bujin Kou, Hui Tang, Manhong Zhou

Abstract

Objectives: To evaluate the resuscitative effects of mechanical and manual chest compression in patients with out-of-hospital cardiac arrest (OHCA).

Methods: All randomized controlled and cohort studies comparing the effects of mechanical compression and manual compression on cardiopulmonary resuscitation in OHCA patients were retrieved from the Cochrane Library, PubMed, EMBASE, and Ovid databases from the date of their establishment to January 14, 2019. The included outcomes were as follows: the return of spontaneous circulation (ROSC) rate, the rate of survival to hospital admission, the rate of survival to hospital discharge, and neurological function. After evaluating the quality of the studies and summarizing the results, RevMan5.3 software was used for the meta-analysis.

Results: In total, 15 studies (9 randomized controlled trials and 6 cohort studies) were included. The results of the meta-analysis showed that there were no significant differences in the resuscitative effects of mechanical and manual chest compression in terms of the ROSC rate, the rate of survival to hospital admission and survival to hospital discharge, and neurological function in OHCA patients (ROSC: RCT: OR = 1.12, 95% CI (0.90, 1.39), P = 0.31; cohort study: OR = 1.08, 95% CI (0.85, 1.36), P = 0.54; survival to hospital admission: RCT: OR = 0.95, 95% CI (0.75, 1.20), P = 0.64; cohort study: OR = 0.98 95% CI (0.79, 1.20), P = 0.82; survival to hospital discharge: RCT: OR = 0.87, 95% CI (0.68, 1.10), P = 0.24; cohort study: OR = 0.78, 95% CI (0.53, 1.16), P = 0.22; Cerebral Performance Category (CPC) score: RCT: OR = 0.88, 95% CI (0.64, 1.20), P = 0.41; cohort study: OR = 0.68, 95% CI (0.34, 1.37), P = 0.28). When the mechanical compression group was divided into Lucas and Autopulse subgroups, the Lucas subgroup showed no difference from the manual compression group in ROSC, survival to admission, survival to discharge, and CPC scores; the Autopulse subgroup showed no difference from the manual compression subgroup in ROSC, survival to discharge, and CPC scores.

Conclusion: There were no significant differences in resuscitative effects between mechanical and manual chest compression in OHCA patients. To ensure the quality of CPR, we suggest that manual chest compression be applied in the early stage of CPR for OHCA patients, while mechanical compression can be used as part of advanced life support in the late stage.

Keywords: Manual chest compression; Mechanical chest compression; Meta-analysis; OHCA; Out-of-hospital cardiac arrest.

Conflict of interest statement

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of the search criteria and the reasons for exclusion
Fig. 2
Fig. 2
Forest plot of the ROSC for RCTs
Fig. 3
Fig. 3
Forest plot of the ROSC for cohort studies
Fig. 4
Fig. 4
Forest plot of survival to admission for RCTs
Fig. 5
Fig. 5
Forest plot of survival to admission for cohort studies
Fig. 6
Fig. 6
Forest plot of survival to discharge for RCTs
Fig. 7
Fig. 7
Forest plot of survival to discharge for cohort studies
Fig. 8
Fig. 8
Forest plot of CPC scores for RCTs
Fig. 9
Fig. 9
Forest plot of CPC scores for cohort studies

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