Mechanical chest compression with LUCAS device does not improve clinical outcome in out-of-hospital cardiac arrest patients: A systematic review and meta-analysis.

Mao Liu,Hui Liu,Zhuang Shuai,Jiankang Zheng,Kai Tang,Jiao Ai,Zhan Lv,Junqi Gou

doi:10.1097/md.0000000000017550

Abstract

Cardiac arrest (CA) is a serious threat to human health. Cardiopulmonary resuscitation (CPR) is an effective treatment for CA. Early and high-quality CPR is closely related to the survival rate of patients with CA. But manual chest compression has a lot of defects. To solve the defects and improve the quality of CPR, mechanical CPR device was invented. However, it has still controversy whether manual chest compression or mechanical chest compression is better. This systematic review was aimed to investigate the difference in clinical outcomes between manual chest compression and Lund University Cardiac Assist System (LUCAS) assisted CPR in patients with out-hospital CA. Original research studies, conducted on adult out-of-hospital CA, were included. PubMed/Medline, EMBASE, Scopus, Cochrane Library, CNKI, and Wanfang database were searched from the setting to February 21, 2019. Odds ratio (OR) with 95% confidence interval (CI) was selected as effect scale index for evaluation of the difference in return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and survival to 30 days. Random effects model was used in this study to estimate overall mean effects. A total of 6 articles, including 4 randomized controlled trials and 2 nonrandomized controlled trials, were selected. And 8501 subjects were involved to analyze the clinical outcomes of LUCAS and manual chest compression for patients with out-hospital CA. Comparisons of ROSC (33.3% vs 33.0%, P = .98; OR = 1; 95% CI: [0.89,1.13]), survival to hospital admission (22.7% vs 24.3%, P = .32; OR = 0.86; 95% CI: [0.65,1.15]), survival to hospital discharge (8.6% vs 10.7%, P = .50; OR = 0.92; 95% CI: [0.73,1.17]), and survival to 30 days (7.5% vs 8.5%, P = .50; OR = 0.92; 95% CI: [0.73,1.17]) were made. No significant difference was found. The synthesis of available evidence does not support that mechanical chest compression with LUCAS device improves clinical outcome in out-of-hospital CA patients compared with manual chest compression. Large scale studies with improved designs are still needed in the future.

Highlights

Cardiac arrest (CA) is the sudden suspension of cardiac ejection function
The success rate of return of spontaneous circulation (ROSC) in the Lund University Cardiac Assist System (LUCAS) group and the Manual group was similar, and the difference was not statistically significant (33.3% vs 33.0%, P = .98, Odds ratio (OR) = 1; 95% confidence interval (CI): [0.89, 1.13])
The replacement personnel will lead to Cardiopulmonary resuscitation (CPR) interruption, which will lead to a decline in CPR quality and affect prognosis of patients with CA.[26,27,28]

Summary

Introduction

Cardiac arrest (CA) is the sudden suspension of cardiac ejection function. Previous retrospective studies have shown that inhospital mortality of CA patients is 67% in adult and 5% in children.[1]. Cardiopulmonary resuscitation (CPR) is an effective treatment by using manual respiration to deliver air into the lung cavity, and simulating the heart pumping function through extra chest compression to supply oxygen to organs. If the time of CPR is more than 10 minutes, the survival rate is only 4.5%.[6] The American Heart Association released a new CPR guideline which emphasizes high-quality CPR as the key to improve prognosis of CA patients.[7,8] manual chest compression is limited by many factors such as the environment, the mental and physical strength of the rescuer. And high-quality CPR is closely related to the survival rate of patients with CA. To solve the defects and improve the quality of CPR, mechanical CPR device was invented It has still controversy whether manual chest compression or mechanical chest compression is better. This systematic review was aimed to investigate the difference in clinical outcomes between manual chest compression and Lund University Cardiac Assist System (LUCAS) assisted CPR in patients with out-hospital CA

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Discussion

Conclusion