Abstract
AimsThe aim of this paper was to conduct a systematic review of the published literature to address the question: “In pre-hospital adult cardiac arrest (asystole, pulseless electrical activity, pulseless Ventricular Tachycardia and Ventricular Fibrillation), does the use of mechanical Cardio-Pulmonary Resuscitation (CPR) devices compared to manual CPR during Out-of-Hospital Cardiac Arrest and ambulance transport, improve outcomes (e.g. Quality of CPR, Return Of Spontaneous Circulation, Survival)”.MethodsDatabases including PubMed, Cochrane Library (including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials), Embase, and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included manikin and human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case series and case reports.ResultsOut of 88 articles identified, only 10 studies met the inclusion criteria for further review. Of these 10 articles, 1 was Level of Evidence (LOE) 1, 4 LOE 2, 3 LOE 3, 0 LOE 4, 2 LOE 5. 4 studies evaluated the quality of CPR in terms of compression adequacy while the remaining six studies evaluated on clinical outcomes in terms of return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and Cerebral Performance Categories (CPC). 7 studies were supporting the clinical question, 1 neutral and 2 opposing.ConclusionIn this review, we found insufficient evidence to support or refute the use of mechanical CPR devices in settings of out-of-hospital cardiac arrest and during ambulance transport. While there is some low quality evidence suggesting that mechanical CPR can improve consistency and reduce interruptions in chest compressions, there is no evidence that mechanical CPR devices improve survival, to the contrary they may worsen neurological outcome.
Highlights
Sudden cardiac arrest is a global concern
Cardiac arrest patients are often transported to the hospital in a ‘scoop and run’ model. This is in contrast to the practice in North American Emergency Medical Services (EMS) systems and European communities, where Cardio-Pulmonary Resuscitation (CPR) is more often performed at scene, and unsuccessful resuscitations may be terminated in the field
The review was conducted in accordance with the methodology recommended by the International Liaison Committee on Resuscitation (ILCOR) 2010 evidence evaluation process [14] where this sought to identify evidence to address the question: [15] “In pre-hospital adult cardiac arrest(pre-hospital [of-hospital cardiac arrest (OHCA)]), does the use of mechanical CPR devices compared to manual CPR during ambulance transport, improve outcomes (e.g. quality of CPR, return of spontaneous circulation (ROSC), survival)”
Summary
Sudden cardiac arrest is a global concern. Over the years, the mechanism of death has shifted from ventricular fibrillation (VF) as initial rhythm to pulseless electrical activity (PEA) and asystole [1,2,3,4]. The incidence of out-of-hospital cardiac arrest (OHCA) in USA has been estimated at 1.89/1,000 person-years and at 5.98/1,000. CPR during OHCA and ambulance transport is a key issue in pre-hospital emergency care. Patients may arrest during transport, or OHCA patients may need to be transported due to local ambulance policies. Cardiac arrest patients are often transported to the hospital in a ‘scoop and run’ model. This is in contrast to the practice in North American Emergency Medical Services (EMS) systems and European communities, where CPR is more often performed at scene, and unsuccessful resuscitations may be terminated in the field
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
