Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human

Abstract

IntroductionCardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960. Mechanical CPR devices are designed to improve chest compression quality, thus considering the improvement of resuscitation outcomes. This protocol outlines a systematic review and meta-analysis methodology to assess trials investigating the therapeutic effect of automated mechanical CPR devices at the rate of return of spontaneous circulation, neurological state and secondary endpoints (including short-term and long-term survival, injuries and surrogate parameters for CPR quality) in comparison with manual chest compressions in adults with cardiac arrest.Methods and analysisA sensitive search strategy will be employed in established bibliographic databases from inception until the date of search, followed by forward and backward reference searching. We will include randomised and quasi-randomised trials in qualitative analysis thus comparing mechanical to manual CPR. Studies reporting survival outcomes will be included in quantitative analysis. Two reviewers will assess independently publications using a predefined data collection form. Standardised tools will be used for data extraction, risks of bias and quality of evidence. If enough studies are identified for meta-analysis, the measures of association will be calculated by dint of bivariate random-effects models. Statistical heterogeneity will be evaluated by I2-statistics and explored through sensitivity analysis. By comprehensive subgroup analysis we intend to identify subpopulations who may benefit from mechanical or manual CPR techniques. The reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Ethics and disseminationNo ethical approval will be needed because data from previous studies will be retrieved and analysed. Most resuscitation studies are conducted under an emergency exception for informed consent. This publication contains data deriving from a dissertation project. We will disseminate the results through publication in a peer-reviewed journal and at scientific conferences.PROSPERO registration numberCRD42017051633.

What is the Optimal Method of Chest Compression Until the Establishment of Extracorporeal Cardiopulmonary Resuscitation (ECPR)? A Comparative Analysis of Mechanical and Manual Chest Compressions - Secondary Analysis of the SAVE-J II Study of Out-of-Hospital Cardiopulmonary Arrest Patients Treated with Extracorporeal Cardiopulmonary Resuscitation

“…While some studies have reported favorable outcomes with mechanical chest compressions in selected patients (1)(7)(8), the current American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) 2020 do not endorse the routine use of mechanical chest compressions based on considerations of quality, safety, feasibility, and practicality (9). However, the guidelines do not provide speci c recommendations on when to use mechanical CPR, such as in which patient populations, under what circumstances, or at what stage of resuscitation (9)(10) (11). In addition, the comparative effectiveness of mechanical versus manual chest compressions remains unclear (4)(9)(10) (12).…”

Comparison between automated cardiopulmonary resuscitation and manual cardiopulmonary resuscitation in the rescue of cardiac and respiratory arrest

“…Studies have shown that A-CPR was superior to M-CPR. 8 , 17 , 19 However, a meta-analysis of nine prospective studies has suggested that mechanical CPR was inferior to manual CPR in terms of attaining ROSC, and no differences in survival to discharge for in-hospital cardiac arrest patients. 11 Khan et al also reported that manual CPR is more effective in improving hospital discharge or survival at 30 days compared with mechanical CPR.…”

“…A-CPR allows adjustment of depth, frequency and proportion of external chest compression according to the specific situation of the patient, and provides constant and lasting ventilation support and external chest compression. 8 Over the past years, numbers of studies have investigated the effectiveness of A-CPR and M-CPR in OHCA patients 9,10,11 , but few in IHCA patients. Therefore, we performed an observational study to analyze the efficacy of A-CPR and M-CPR in the rescue of cardiac and respiratory arrest by comparing their rescue effect, blood gas analysis index and respiratory dynamics, and condition improvement.…”

“…A-CPR allows adjustment of depth, frequency and proportion of external chest compression according to the specific situation of the patient, and provides constant and lasting ventilation support and external chest compression. 8 …”

Cardiopulmonary Resuscitation Performed by Bystanders: A Systematic Review

“…However, providing high-quality CPR has been proven to be insufficient in a variety of contexts, particularly among community members. This is concerning since CPR is intrinsically inefficient, producing just a third of normal cardiac blood flow and cerebral blood flow when performed according to standards (52). Qualified rescuers must perform high-quality CPR to improve the chances of restoring spontaneous circulation.…”