Comparison between Prehospital Mechanical Cardiopulmonary Resuscitation (CPR) Devices and Manual CPR for Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.

Cheng-Ying Chiang,Pei Chun Lai,Ming-Jen Tsai,Ket-Cheong Lim,Tou-Yuan Tsai,Yen Ta Huang

doi:10.3390/jcm11051448

Abstract

In pre-hospital settings, efficient cardiopulmonary resuscitation (CPR) is challenging; therefore, the application of mechanical CPR devices continues to increase. However, the evidence of the benefits of using mechanical CPR devices in pre-hospital settings for adult out-of-hospital cardiac arrest (OHCA) is controversial. This meta-analysis compared the effects of mechanical and manual CPR applied in the pre-hospital stage on clinical outcomes after OHCA. Cochrane Library, PubMed, Embase, and ClinicalTrials.gov were searched from inception until October 2021. Studies comparing mechanical and manual CPR applied in the pre-hospital stage for survival outcomes of adult OHCA were eligible. Data abstraction, quality assessment, meta-analysis, trial sequential analysis (TSA), and grading of recommendations, assessment, development, and evaluation were conducted. Seven randomized controlled and 15 observational studies were included. Compared to manual CPR, pre-hospital use of mechanical CPR showed a positive effect in achieving return of spontaneous circulation (ROSC) and survival to admission. No difference was found in survival to discharge and discharge with favorable neurological status, with inconclusive results in TSA. In conclusion, pre-hospital use of mechanical CPR devices may benefit adult OHCA in achieving ROSC and survival to admission. With low certainty of evidence, more well-designed large-scale randomized controlled trials are needed to validate these findings.

Highlights

Studies were included if the participants were adult patients with of-hospital cardiac arrest (OHCA), the intervention was the use of an automated mechanical cardiopulmonary resuscitation (CPR) device in the prehospital stage, the comparison was with manual CPR, and the outcome indicators were survival-related outcomes
We reviewed the references of eligible papers, similar articles recommended by the PubMed algorithm, and published systematic reviews to identify candidate trials that were not listed in the original database
Of 47 articles assessed for eligibility, 21 articles were included, after excluding articles investigating different populations (IHCA and aircraft rescue) (n = 14), in-hospital use of mechanical CPR device (n = 3), different outcomes (n = 6), crossover study (n = 1), and no raw data for retrieval (n = 2)

Summary

Introduction

Out-of-hospital cardiac arrest (OHCA) is a universal concern [1]. The global incidence is approximately 30–97 individuals per 100,000 person-years [2,3]. The management of OHCA has progressed, the survival rate remains poor, around 3.1% to 20.4%. Achieving survival from OHCA relies on implementing the integral chain of survival [5]. It includes early activation of the emergency medical services (EMS)

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