Mechanical Versus Manual Chest Compression for Neurological Outcomes in Patients with Cardiac Arrest: A Meta-Analysis

BACKGROUND: Mechanical chest compression devices have been developed to improve the effectiveness of cardiopulmonary resuscitation (CPR). But the neurological benefit of mechanical chest compression is uncertain. OBJECTIVES: To assess the effectiveness of mechanical chest compression versus manual chest compression on the neurological outcomes in patients who suffered cardiac arrest using a meta-analysis. METHODS: By searching the Cochrane library, Pubmed, Embase and Web of Science datebase, 10 clinical controlled trials from 1990 to July 2018 were included our study, and 6 trials among them were to compare the neurological outcomes of mechanical chest compression and manual chest compression. We used the Cochrane Collaboration Network Risk Assessment Tool and the Newcastle-Orrawa Scale (NOS) for quality assessment and RevMan 5.3 for data analysis. Use relative risk (RR) and 95% confidence interval (CI) to pool the effect. RESULTS: Compared with manual chest compression, mechanical chest compression did not significantly improve survival with good neurological outcome to hospital discharge (RR 0.78, 95% CI 0.60-1.00, P = 0.05), ROSC (RR = 0.97,95% CI 0.92-1.02, p = 0.20, I-2 = 38%) and short-term (survival to hospital admission or survival to 4 hours) survival (RR = 1.00,95% CI 0.92-1.09, p = 0.97, I-2 = 0%;). In addition, compared with manual chest compression, mechanical chest compression were associated with higher survival to hospital discharge (RR = 0.86,95% CI 0.76-0.97, p = 0.01,I-2 = 36%). CONCLUSION: Mechanical chest compression devices should not be recommended to be used conventionally during CPR in adult patients with cardiac arrest.