title: Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies.
abstract: OBJECTIVE
  Mechanical chest compression devices have been developed to facilitate continuous delivery of high-quality cardiopulmonary resuscitation (CPR). Despite promising hemodynamic data, evidence on clinical outcomes remains inconclusive. With the completion of 3 randomized controlled trials, we conduct a meta-analysis on the effect of in-field mechanical versus manual CPR on clinical outcomes after out-of-hospital cardiac arrest.
  
  
  METHODS
  With a systematic search (PubMed, Web of Science, EMBASE, and the Cochrane Libraries), we identified all eligible studies (randomized controlled trials and nonrandomized studies) that compared a CPR strategy including an automated mechanical chest compression device with a strategy of manual CPR only. Outcome variables were survival to hospital admission, survival to discharge, and favorable neurologic outcome.
  
  
  RESULTS
  Twenty studies (n=21,363) were analyzed: 5 randomized controlled trials and 15 nonrandomized studies, pooled separately. For survival to admission, the pooled estimate of the randomized controlled trials did not indicate a difference (odds ratio 0.94; 95% confidence interval 0.84 to 1.05; P=.24) between mechanical and manual CPR. In contrast, meta-analysis of nonrandomized studies demonstrated a benefit in favor of mechanical CPR (odds ratio 1.42; 95% confidence interval 1.21 to 1.67; P<.001). No interaction was found between the endorsed CPR guidelines (2000 versus 2005) and the CPR strategy (P=.27). Survival to discharge and neurologic outcome did not differ between strategies.
  
  
  CONCLUSIONS
  Although there are lower-quality, observational data that suggest that mechanical CPR used at the rescuer's discretion could improve survival to hospital admission, the cumulative high-quality randomized evidence does not support a routine strategy of mechanical CPR to improve survival or neurologic outcome. These findings are irrespective of the endorsed CPR guidelines during the study periods.
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: judithbonnes@gmail.com.
authors.forename: Judith L
authors.initials: JL
authors.lastname: Bonnes
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Brouwer
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Eliano P
authors.initials: EP
authors.lastname: Navarese
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Dominique V M
authors.initials: DV
authors.lastname: Verhaert
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Freek W A
authors.initials: FW
authors.lastname: Verheugt
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Joep L R M
authors.initials: JL
authors.lastname: Smeets
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Menko-Jan
authors.initials: MJ
authors.lastname: de Boer
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006336:Heart Massage / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D064887:Observational Studies as Topic; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis