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Traumatic Injuries Following Mechanical versus Manual Chest Compression
Safwat Saleem1, Roman Sonkin2, Iftach Sagy3,4
1Emergency Department, Rabin Medical Center - Beilinson Hospital, Petach-Tikva, Israel.
Open Access Emergency Medicine : OAEM
|October 11, 2022
Summary
Mechanical chest compression devices (ACD) did not increase skeletal fractures or internal injuries compared to manual cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) patients. The LUCAS device showed no added benefit for return of spontaneous circulation (ROSC).
Area of Science:
- Emergency Medicine
- Cardiology
- Resuscitation Science
Background:
- Survival from out-of-hospital cardiac arrest (OHCA) is heavily influenced by chest compression quality.
- Studies comparing manual chest compressions with mechanical active compression-depression (ACD) devices have produced conflicting outcomes regarding efficacy and patient injury.
- The safety and effectiveness of ACD devices in OHCA require further investigation.
Purpose of the Study:
- To compare the incidence of skeletal fractures and/or internal injuries between mechanical ACD devices and manual chest compressions in OHCA patients.
- To assess the association between ACD device use and the rate of return of spontaneous circulation (ROSC).
- To identify clinical factors influencing skeletal injury and ROSC achievement during cardiopulmonary resuscitation (CPR).
Main Methods:
- A cohort study included 107 OHCA patients who achieved ROSC at a tertiary medical center between January 2018 and June 2019.
- Patients were divided into two groups: manual chest compression (n=45) and mechanical ACD device (LUCAS) (n=62).
- Primary outcome was the incidence of skeletal fractures and/or internal injuries; secondary outcomes included ROSC rates and contributing clinical factors.
Main Results:
- Chest compression duration was similar between groups (46.0 min manual vs. 48.5 min ACD, p=0.82).
- No significant differences were observed in ROSC rates (53.2% vs. 50.8%, p=0.84), major complications (20.5% vs. 12.1%, p=0.28), or any complications.
- Multivariate analysis identified cardiac etiology (OR 1.94) and female sex (OR 1.94) as predictors of ROSC; LUCAS use was not associated with ROSC (OR 0.73).
Conclusions:
- This study is the first to directly compare mechanical and manual chest compressions of similar duration in OHCA patients achieving ROSC.
- The LUCAS ACD device did not demonstrate improved ROSC rates and was not associated with an increased risk of traumatic injury.
- ACD devices may offer benefits in specific scenarios, such as delayed emergency medical services response or remote resuscitation efforts.
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