Mechanical versus Manual Chest Compressions for Cardiopulmonary Resuscitation in Emergency Department: A Comparative...

Mechanical chest compression devices provide consistent depth and reduced pauses during cardiopulmonary resuscitation (CPR), but their clinical impact on routine practice in emergency department (ED) remains uncertain. This study aimed to compare the outcomes of mechanical versus manual compressions among adults with in-hospital cardiac arrest managed in ED.

A single-center, comparative study of consecutive adult cardiac arrests in the ED (n = 372) was carried out. Patients were allocated by time period to either manual CPR (n = 195) during the retrospective phase (September 2024 to January 2025) or mechanical CPR (n = 177) with LUCAS-3 during the prospective phase (January to June 2025). The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes were survival at 6 hours and 24 hours post-arrest. Baseline differences were summarized with standardized mean differences, and survival was described with Kaplan-Meier curves (0-24 h). Logistic regression estimated odds ratios (ORs) for ROSC and 6-hour survival.

Mechanical and manual chest compression groups comprised 177 and 195 patients, respectively. Unadjusted outcomes favored mechanical CPR. ROSC occurred in 54 (30.5%) versus 32 (16.4%), with an absolute risk difference of 14.1% and Six-hour survival was 25 (14.1%) versus 5 (2.6%). After adjustment, mechanical CPR remained associated with higher odds of ROSC (OR = 2.44, 95% confidence interval (CI): 1.18-4.42) and 6-hour survival (OR = 6.71, 95% CI: 2.94-18.94). By 24 hours, no patient survived in the mechanical group, whereas one patient (0.5) survived in the manual group (P>0.05). Kaplan-Meier curves showed early separation that narrowed by 24 hours.

It seems that mechanical chest compression during CPR is associated with increased ROSC and better early survival, compared to manual compression. Due to the limited sample size, non-randomized design with time-based allocation, single-center setting, potential residual confounding, and absence of neurologic outcomes, these results should be interpreted with caution.