A Meta-analysis Of The Resuscitation Effects Of Mechanical And Manual Chest Compression On Out-of-hospital Cardiac Arrest Patients

Objective: To evaluate the resuscitative effects of mechanical and manual chest compression in patients with out-of-hospital cardiac arrest(OHCA).Methods: All randomized controlled trials and cohort studies comparing the effects of mechanical compression and manual compression on cardiopulmonary resuscitation in OHCA patients were retrieved from the Cochrane Library,PubMed,EMBASE,and Ovid databases from the date of their establishment to 2019-01-14.Inclusion criteria:(1)Patients or participants: the included participants were OHCA patients.(2)Intervention measures: the comparison was between mechanical compression and manual compression.(3)Outcome indicators: the outcome indicators included primary outcome indicators,such as the rate of the ROSC,and secondary outcome indicators,such as the rate of survival to hospital admission,the rate of survival to hospital discharge,and CPC scores.(4)Study type: the included studies were RCTs or cohort studies.The exclusion criteria were as follows:(1)the study lacked a control group or was not one of the two included types of studies.(2)The study included children younger than 18 years,animal studies,or simulation studies.(3)The original text could not be obtained,and the available information was insufficient.(4)The original data could not be transformed to be used in this study.(5)Repeated articles.The literature was screened and managed by the EndNote software.The quality of the included studies was independently evaluated according to the Cochrane Collaboration’s tool for assessing risk of bias and the Newcastle Ottawa Scale(NOS).This study used the Cochrane Collaboration’s tool for assessing risk of bias to evaluate the RCTs;the Cochrane Collaboration’s tool for assessing risk of bias assessed the generation of random sequences,randomized concealment,blinding,and the description of outcomes.The NOS scale was used for the cohort studies;it included the selection of the cohort,the comparability between groups.The extraction of research data included year of publication,authors’ names,country,and type of mechanical compression examined.The relevant physiological indexes and prognostic indicators included the ROSC rate,the rate of survival to hospital admission,the rate of survival to discharge and the CPC score.RevMan5.3 software was used for the meta-analysis.Results: In total,25 studies(9 randomized controlled trials and 16 cohort studies)were included.The results of the meta-analysis showed that there were no significant differences in the resuscitative effects of mechanical chest compression and manual chest compression in terms of the ROSC rate,the rate of survival to hospital admission,the rate of survival to hospital discharge,and CPC scores in OHCA patients from RCTs;In the cohort study,manual compression was superior to mechanical compression in terms of discharge survival rate and CPC score of OHCA patients.(ROSC: RCT: RR=1.06,95% CI(0.93,1.21),P=0.35;cohort study: RR =1.07,95% CI(0.91,1.25),P =0.40;survival to hospital admission: RCT: RR=0.95,95% CI(0.77,1.18),P=0.67;cohort study: RR =1.05,95% CI(0.90,1.21),P=0.54;survival to hospital discharge: RCT: RR=0.88,95% CI(0.72,1.09),P=0.24;cohort study: RR=0.68,95% CI(0.57,0.81),P<0.01;Cerebral Performance Category(CPC)score: RCT: RR=0.89,95% CI(0.67,1.18),P=0.41;cohort study: RR=0.58,95% CI(0.46,0.73),P<0.01).When the mechanical compression group was divided into Lucas and Autopulse subgroups,the subgroups showed no difference from the manual compression group in ROSC,survival to admission,survival to discharge and CPC scores.(ROSC: Lucas: RR=1.03,95% CI(0.96,1.10),P=0.44;Autopulse: RR=1.18,95% CI(0.85,1.66),P =0.32;survival to hospital admission: Lucas: RR=1.00,95% CI(0.86,1.17),P=0.95;Autopulse: RR =1.22,95% CI(0.93,1.62),P =0.15;survival to hospital discharge: Lucas: RR=0.88,95% CI(0.73,1.06),P=0.19;Autopulse: RR=0.90,95% CI(0.55,1.46),P=0.66;Cerebral Performance Category(CPC)score: Lucas: RR=0.81,95% CI(0.60,1.10),P =0.19;Autopulse: RR=0.82,95% CI(0.27,2.53),P =0.73)Conclusion:(1)The results of the meta-analysis showed that mechanical chest compression was not superior to manual chest compression,cohort studies showed that manual compression was likely to be superior to mechanical compression in terms of discharge survival rate and CPC scores.(2)It demonstrated that manual compression is more advantageous because it can be implemented in a timely and effective manner,while mechanical compression tends to cause more complications.