title: Mechanical chest compression devices at in-hospital cardiac arrest: A systematic review and meta-analysis.
abstract: To summarise the evidence in relation to the routine use of mechanical chest compression devices during resuscitation from in-hospital cardiac arrest.
  
  
  
  We conducted a systematic review of studies which compared the effect of the use of a mechanical chest compression device with manual chest compressions in adults that sustained an in-hospital cardiac arrest. Critical outcomes were survival with good neurological outcome, survival at hospital discharge or 30-days, and short-term survival (ROSC/1-h survival). Important outcomes included physiological outcomes. We synthesised results in a random-effects meta-analysis or narrative synthesis, as appropriate. Evidence quality in relation to each outcome was assessed using the GRADE system.
  
  
  
  Studies were identified using electronic databases searches (Cochrane Central, MEDLINE, EMBASE, CINAHL), forward and backward citation searching, and review of reference lists of manufacturer documentation.
  
  
  
  Eight papers, containing nine studies [689 participants], were included. Three studies were randomised controlled trials. Meta-analyses showed an association between use of mechanical chest compression device and improved hospital or 30-day survival (odds ratio 2.34, 95% CI 1.42-3.85) and short-term survival (odds ratio 2.14, 95% CI 1.11-4.13). There was also evidence of improvements in physiological outcomes. Overall evidence quality in relation to all outcomes was very low.
  
  
  
  Mechanical chest compression devices may improve patient outcome, when used at in-hospital cardiac arrest. However, the quality of current evidence is very low. There is a need for randomised trials to evaluate the effect of mechanical chest compression devices on survival for in-hospital cardiac arrest.
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK; Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Couper
authors.affiliation: Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK; School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.
authors.forename: Joyce
authors.initials: J
authors.lastname: Yeung
authors.affiliation: Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nicholson
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University London and St. George's, University of London, London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Quinn
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Ranjit
authors.initials: R
authors.lastname: Lall
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK; Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK. Electronic address: g.d.perkins@warwick.ac.uk.
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Perkins
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods*; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006336:Heart Massage / Q000295:instrumentation / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Advanced life support; Cardiac arrest; In-hospital cardiac arrest; Mechanical chest compression device