Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation

Mechanical chest compression has been shown to be equivalent to manual chest compression in providing survival benefits to patients experiencing cardiac arrest. There has been a growing need for a contemporary review of iatrogenic injuries caused by mechanical in comparison with manual chest compression. Our study aims to analyze the studies that document significant life-threatening iatrogenic injuries caused by mechanical and manual chest compression.

A systematic review of PubMed and Embase was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. All studies published after January 1^st, 2000 were reviewed using inclusion/exclusion criteria and completed by May 2020. A total of 7202 patients enrolled in 15 studies were included in our meta-analysis.

Significant life-threatening iatrogenic injuries had higher odds of occurring when mechanical chest compression was used compared to manual chest compression, especially for hemothorax and liver lacerations. Mechanical chest compression involves consistently deeper compression depths compared to manual chest compression, potentially resulting in more injuries. In the mechanical chest compression cohort, chest wall fractures had the highest incidence rate (55.7%), followed by sternal fracture (28.3%), lung injuries (3.7%), liver (1.0%), and diaphragm (.2%) lacerations.

Mechanical chest compression was associated with more iatrogenic injuries as compared to manual chest compression. Further research is needed to define the appropriate application of mechanical in comparison with manual chest compression in different scenarios. Levels of provider training, different mechanical chest compression device types, patient demographics, and compression duration/depth may all play roles in influencing outcomes.