Abstract 80: Mechanical vs Manual Chest Compressions in Out-of-Hospital Cardiac Arrest: Meta-analysis on the Effects on Return of Spontaneous Circulation

Abstract

Background: Morbidity and mortality rates for out-of-hospital cardiac arrest (OHCA) remain high. A load-distributing band (LDB-CPR) device that provides circumferential thoracic compressions and a piston-driven device with active compression/decompression (PD-CPR) that provides sternal compressions are commercially available automated mechanical chest compression devices designed to supplement conventional CPR (C-CPR). To date, short-term survival data of LDB-CPR and PD-CPR vs. C-CPR are limited and inconclusive. A larger body of data exists on the effects of return of spontaneous circulation (ROSC) for these devices. Methods: A meta-analysis was performed to compare LDB-CPR and PD-CPR to C-CPR with the primary endpoint of ability to achieve ROSC. Selection criteria for the meta-analysis required that studies must be human controlled (randomized, phased, historical or case-control) investigations with confirmed OHCA cases. Random effects models were used to assess the relative effect of treatments on ROSC. Result: A total of 13 studies (LDB-CPR vs. C-CPR = 8, PD-CPR vs. C-CPR = 5), comprising a total of 6664 subjects with 1884 ROSC events, met the selection criteria. When compared to C-CPR, LDB-CPR had a significantly greater odds of ROSC (odds ratio (OR) = 1.62; 95CI%= 1.36, 1.92, p<0.001) (Figure). The treatment effect for PD-CPR was not significant (OR = 1.15; 95CI%= 0.87, 1.51, p=0.331). Conclusion: The ability to achieve ROSC with general automated mechanical chest compression devices is, at the least, comparable to C-CPR. In the case of LDB-CPR, it was superior to C-CPR as the odds of ROSC were over 1.5 times greater and statistically significant. The robustness of these findings should be confirmed in large randomized controlled clinical trials.