Mechanical devices for chest compression: to use or not to use?

Abstract

The delivery of high-quality manual chest compressions is rarely achieved in practice. Mechanical chest compression devices can consistently deliver high-quality chest compressions. The recent publication of large prehospital trials of these devices provides important new information about the role of these devices. The Circulation Improving Resuscitation Care (CIRC), LUCAS in cardiac arrest (LINC) and Prehospital Randomized Assessment of a Mechanical Compression Device (PARAMEDIC) trials have recently been published. All these large prehospital trials found that the routine use of mechanical compression devices in the prehospital setting did not improve survival rates compared to those observed with manual chest compressions. There remain limited data on the routine use of devices during in-hospital cardiac arrest. Observational studies report favourable outcomes with the use of mechanical devices in special circumstances, including as a bridge to advanced therapies such as extracorporeal membrane oxygenation. Mechanical cardiopulmonary resuscitation (CPR) results in similar survival rates to manual CPR in out of hospital cardiac arrest. There are insufficient data to support or refute the routine use of mechanical CPR devices during in-hospital cardiac arrest. Observational studies demonstrate the feasibility of using mechanical CPR when manual CPR is difficult or impossible, and as a bridge to advanced therapies.