Manual chest compressions outperform mechanical: meta-analysis of RCTs

  • Khan SU & al.
  • Resuscitation
  • 7 May 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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  • 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.

Key results

  • 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.

Study design

  • 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.

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