For patients in cardiac arrest receiving cardiopulmonary resuscitation (CPR), manual compressions are associated with substantially better rates of 30-day survival and discharge than are automated compressions.
Why this matters
- Survival of out-of-hospital cardiac arrest in the United States has been estimated at 12%.
- High-quality chest compressions during CPR are difficult to deliver.
- AutoPulse (Zoll Medical Corporation, Chelmsford, MA) and LUCAS (Physio-Control/Jolife AB, Lund, Sweden) are FDA-approved devices that deliver chest compressions.
- Evidence of device efficacy and safety is mixed.
- Previous meta-analyses included observational data.
- Manual compression vs AutoPulse:
- Survival or discharge: OR, 1.40 (95% credible interval, 1.09-1.94).
- Neurological recovery: OR, 1.51 (1.06-2.39).
- Pneumothorax: OR, 0.56 (0.33-0.97).
- Hematoma: OR, 0.15 (0.01-0.73).
- LUCAS vs AutoPulse:
- Hematoma: OR, 0.07 (0.00-0.43).
- All had similar rates of survival to hospital admission, return of spontaneous circulation.
- With manual compression, highest probability of survival or discharge, survival to hospital admission, neurological improvement; lowest probability of tension pneumothorax.
- With AutoPulse, lowest probability of visceral damage.
- Systematic review, Bayesian network meta-analysis of 7 randomized controlled trials comparing manual to automatic compressions during CPR for cardiac arrest (mostly out-of-hospital; total n=12,908).
- Primary outcome: 30-day survival or hospital discharge.
- Funding: None disclosed.
Heterogeneous, open-label studies.