The Efficacy And Safety Of Mechanical And Manual Chest Compression On Patients Of Cardiac Arrest

Objective: Since the clinical application of the mechanical chest compression devices,scholars have done a lot of researches.While,there is still no evidence-based medical proved that mechanical chest compression is better than manual chest compression.In this review,we aim to evaluate the efficacy and safety of mechanical and manual chest compression on patients of cardiac arrest,guiding the rational use of the mechanical devices in clinical practice.Methods: Datebases such as PubMed,Embase,Web of science,Cochrane Library,CBM,Wanfang,CNKI were searched from the date of their foundation to January 3rd in 2020.Two evaluators extracted the literatures and evaluated the qualities of the literatures separately.The articles satisfied the standards of comparing mechanical chest compression with manual chest compression on patients of out-of-hospital cardiac arrest(OHCA)or in-hospital cardiac arrest(IHCA).OHCA and IHCA studies,randomized controlled studies and cohort studies were analyzed separately.The meta-analysis was used to evaluate the return of spontaneous circulation(ROSC),the rate of survival to hospital admission,the rate of survival to hospital discharge and the rate of good neurological function recovery.The systematic review was used to evaluated the incidence of iatrogenic injuries.Results: This review included 42 papers,containing 45 studies.17 studies were randomized controlled studies and 28 studies were cohort studies.The result of metaanalysis showed that(1)OHCA: there were no significant differences in the resuscitative effects of mechanical chest compression and manual chest compression in terms of the rate of ROSC,survival to hospital admission,survival to hospital discharge and good neurological function recovery in RCTs [ROSC: RR=1.05,95%CI(0.95,1.16),P=0.36;survival to hospital admission: RR=0.95,95%CI(0.77,1.18),P=0.65;survival to hospital discharge: RR=0.94,95%CI(0.83,1.05),P=0.28;good neurological function recovery: RR=0.90,95%CI(0.68,1.19),P=0.46].In the cohort studies,manual chest compression was superior than mechanical chest compression in terms of the survival to hospital discharge and good neurological function recovery [survival to hospital discharge: RR=0.82,95%CI(0.72,0.93),P=0.002;good neurological function recovery: RR=0.72,95%CI(0.61,0.86),P=0.0002].There were no significant differences in terms of the rate of ROSC and survival to hospital admission [ROSC: RR=1.15,95%CI(0.98,1.34),P=0.09;survival to hospital admission: RR=1.18,95%CI(1.00,1.39),P=0.06].(2)IHCA: mechanical chest compression was superior than manual chest compression in terms of the rate of ROSC and survival to hospital discharge in RCTs [ROSC: RR=1.35,95%CI(1.05,1.72),P=0.02;survival to hospital discharge: RR=2.08,95%CI(1.15,3.76),P=0.02].There was no significant differences in terms of the good neurological function recovery in single RCT [RR=1.13,95%CI(0.13,9.72),P=0.91].There was no significant differences in terms of the rate of ROSC in cohort studies [RR=1.53,95%CI(0.82,2.85),P=0.18].The results showed that the mechanical chest compression was superior than the manual chest compression in terms of the rate of survival to hospital discharge in single cohort study [RR=2.58,95%CI(1.26,5.30),P=0.01].There was no significant difference in terms of the good neurological function recovery in single cohort study [RR=4.20,95%CI(0.99,17.87),P=0.05].(3)The results of subgroup analysis for the main outcome indicator(ROSC)on OHCA patients showed that the mechanical chest compression was better than the manual chest compression in Asia [RR=1.29,95%CI(1.03,1.63),P=0.03].There was no statistically significant difference between the mechanical and manual chest compression in Europe,America,Oceania [Europe: RR=1.15,95%CI(0.99,1.33),P=0.07;America: RR=0.89,95%CI(0.74,1.07),P=0.23;Oceania: RR=0.91,95%CI(0.74,1.12),P=0.38].(4)The results of subgroup analysis according to the devices showed that there was no significant difference on OHCA patients between mechanical and manual chest compression in the rate of ROSC [LUCAS: RR=1.00,95%CI(0.96,1.05),P=0.95;AutoPulse: RR=1.41,95%CI(0.95,2.10),P=0.09].(4)The systematic review showed that there were 5 studies showed a higher incidence of mechanical chest compression than manual chest compression in rib fractures among the studies of using LUCAS devices.There were 6 studies showed a higher incidence of mechanical chest compression than manual chest compression in sternum fractures and 3 studies showed that mechanical chest compression caused more visceral-related injuries,including life-threatening visceral injuries.There were 2 studies showed a higher incidence of mechanical chest compression than manual chest compression in rib fractures among the studies of using AutoPulse devices.There were 2 studies showed a lower incidence of mechanical chest compression than manual chest compression in sternum fractures and 1 study showed that the use of AutoPulse devices resulted in more visceral-related injuries,including life-threatening visceral injuries.Conclusion:(1)Mechanical chest compression can’t improve the rate of short and longterm survival and the rate of good neurological recovery for OHCA patients compared with manual chest compression.While,mechanical chest compression can’t be inferior to manual chest compression in improving the rate of short-term survival of IHCA patients.It can’t be ruled out that mechanical chest compression can cause more bone and visceral injuries on patients and the occurrence of fatal iatrogenic injuries associated with resuscitation can’t be ruled out,either.(2)At present,mechanical chest compression can be used as an auxiliary treatment method to IHCA in a relatively stable emergency environment and the rescuers’ energy was limited.