Mechanical chest compression versus manual chest compression for cardiopulmonary resuscitation for cardiac arrest patients: A systematic review and meta-analysis

Abstract

Background: Cardiac arrest (CA) is high-risk for death and hard to rescue. There are two methods of chest compression: mechanical and manual. However, it remains unclear which provides better outcomes for patients. Therefore, we perform a systematic review and meta-analysis for the efficacy of the two methods for CA patients. Method: Randomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCTs) were searched from the Cochrane Library, PubMed, EMBASE, and Web of Science from the date of their establishment to 2 March 2024. RCTs were evaluated using Cochrane randomized trial bias risk tool and the Newcastle–Ottawa Scale for non-RCTs. All statistical analyses were performed using Stata v18.0 and Review Manager v5.4. Results: Twenty-four studies included 10 RCTs and 14 non-RCTs, and 224,245 CA patients. Manual extracorporeal cardiopulmonary resuscitation (CPR) may benefit CA patients in achieving return of spontaneous circulation (ROSC) (odds ratio [OR] = 0.90; 95% CI: 0.813–0.996; Z = −2.04; p = 0.04), admission survival rate (OR = 0.87; 95% CI: 0.80–0.94; Z = −3.64; p < 0.05), and discharge survival rate (OR = 0.80; 95% CI: 0.66–0.98; Z = −2.21; p = 0.03). However, there was no significant difference in 30-day survival rate (OR = 0.80; 95% CI: 0.43–1.48; Z = −0.72; p = 0.47), good restoration of neurologic functions (OR = 0.79; 95% CI: 0.60–1.05; Z = −1.46; p = 0.15), and complication rate (OR = 0.91; 95% CI: 0.47–1.75; Z = −0.29; p = 0.78). Conclusion: Manual CPR showed advantages in ROSC, admission survival rate, and discharge survival rate, whereas there was no significant difference in 30-day survival rate, good recovery of neurological function, and complication compared with mechanical chest compression. Compared with previous systematic reviews and meta-analyses, this study is the first to report the advantages of manual CPR in ROSC. Large sample size and high-quality RCTs are needed, as the existing evidence primarily comes from non-RCTs.