National Comparison of Mechanical Chest Compression Devices and Manual Cardiopulmonary Resuscitation in Trauma and Nontrauma Patients

Abstract

INTRODUCTION: Most trials comparing mechanical chest compression devices and manual CPR exclude trauma patients. The purpose of this study was to perform a retrospective comparison of mechanical chest compression devices and manual CPR in trauma and nontrauma patients. METHODS: The National Emergency Medical Services Information System (NEMSIS) database was queried for all patients undergoing CPR in 2020. The primary outcome was the return of spontaneous circulation (ROSC). Chi-square tests and multivariable logistic regression were performed. RESULTS: There were 160,838 patients undergoing CPR during the study period. The rate of ROSC was 24.8% (n = 39,813). A mechanical compression device was used in 15.0% (n = 24,170), and trauma patients composed 6.3% (p = 10,072). The rate of ROSC with device use was 20.0% (n = 4,838, p < 0.001). Multivariable logistic regression found a decreased likelihood of ROSC with device use (odds ratio 0.73 [0.70 to 0.75], p < 0.001) and in trauma patients (odds ratio 0.39 [0.37 to 0.42], p < 0.001). Subgroup analysis of only trauma patients found that the rate of ROSC was 13.0% (n = 1,312). The rate of ROSC with device use in trauma patients was 11.7% (n = 146, p = 0.14). CONCLUSION: The likelihood of achieving ROSC was decreased in patients when a mechanical chest compression device was used. When evaluating only trauma patients, the rate of ROSC was decreased and was further decreased when a device was used. However, this decreased rate was not statistically significant compared with manual CPR. Further randomized controlled trials comparing mechanical vs manual chest compressions in trauma patients are warranted.