Use of Mechanical Compression Devices Verses Manual Compression
Use of Mechanical Compression Devices verses Manual Compression
Appraised by:
Joshua Schneider SN, Carrie Giesler SN, Dianne Rodriguez SN, and
Jeremiah Majerus SN
NDSU School of Nursing LPN-BSN
Clinical Question:
In patients experiencing a cardiac arrest out of the hospital, does the use of mechanical device CPRor manual CPR compression increase the likelihood of a spontaneous return of circulation?
Articles:
Anantharaman, V., Ng, B. B., Shiang Hu, A., Lee, C. F., Leong, S. B., Eng Hock Ong,
M., & ... Hao, Y. (2017). Prompt use of mechanical cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the MECCA study report.Singapore Medical Journal,58 (7), 424-431.doi:10.11622/smedj.2017071
Perkins, G.D., Lall, R., Quinn, T., Deakin, C.D., Cooke, M., Horton, J., ... Gates, S.
(2015). Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): A pragmatic, cluster randomised controlled trial. The Lancet, 385(9972), 947-955. doi.org/10.1016/
Westfall, M., Krantz, S., Mullin, C., & Kaufman, C. (2013). Mechanical versus manual
chest compressions in out-of-hospital cardiac arrest. Critical Care Medicine, 41(7), 1782-1789. doi:10.1097/ccm.0b013e31828a24e3
Yuksen, C., Prachanukool, T., Aramvanitch, K., Thongwichit, N., Sawanyawisuth, K., & Sittichanbunch, Y. (2017). Is a mechanical-assist device better than manual chest compression? A randomized controlled trial. Open Access Emergency Medicine, 2017(9), 63-67. doi.org/10.2147/OAEM.S133074
Synthesis of Evidence:
Four articles were reviewed as evidence in this report. One study was a meta-analysis of literature, cluster randomized trial, and two randomized controlled trials.
The study done by Anantharaman et al. (2017) was a one year randomized control trial that focused on the comparison of mechanical and manual interventions when it pertained to chest compressions in a cardiopulmonary resuscitation in out of hospital settings. This study included 1,191 participants 21 years of age and older that suffered an out of hospital cardiac arrest (OHCA) of presumed cardiac origin. The interventions included: manual chest compressions and chest compressions with a Lund University Cardiopulmonary Assist System (LUCAS). The findings concluded that the return of spontaneous circulation and mortality rates with the timely use of a mechanical compression device was greater than that of patients that had timely manual chest compressions.
The cluster randomized trial by Perkins et al. (2014) assessed whether the LUCAS-2 device offered better rates of survival (30-day) and spontaneous return of circulation than manual CPR. In this trail 4471 eligible patients (trial vehicle was first ambulance service vehicle on scene, patient was in cardiac arrest outside of a hospital, resuscitation attempted, patient was known/believed to be 18 years of age or older) were included in the trial. Out of the eligible patients, 1652 were assigned to the LUCAS-2 group, while 2819 were assigned to the control group. The findings showed that survival rates and the likelihood of return of spontaneous circulation were equal. This study concluded that there was no clinical significance in either treatment.
Westfall, Krantz, Mullin, & Kaufman (2013) conducted a meta-analysis of 12 studies, 6,538 subjects, with 1,824 return of spontaneous circulation events. The interventions included: load-distributing band cardiopulmonary resuscitation compared to manual resuscitation in eight studies, and piston-driven cardiopulmonary resuscitation compared to manual resuscitation in four studies. The combination of both findings indicate a significant treatment effect of higher return of spontaneous circulation odds when mechanical compression devices are used over manual cardiopulmonary resuscitation, in cardiac arrest patients in the pre-hospital setting.
Yuksen et al. (2017) conducted a randomized trail. No live test subjects were used, only a CPR dummy. This study found that the difference between manual compression and the use of the CPR manual device was statistically significant in the following: average duration of chest compression, average chest compression rate, and average chest compression depth. There was no statistically significance difference in the following areas: percentage of shallow compression, incorrect location of chest compression, and incomplete release of chest compression.
Conclusion:
Of the four articles reviewed, three articles indicated an increased rate of spontaneous circulation with the use of mechanical compressions devices over manual compression, while one article showed improved duration, compression rate and compression depth when using mechanical compressions.
Implications for Nursing Practice:
Timely mechanical resuscitation can decrease the mortality rates of individuals that have achieved ROSC at 24hrs, end of hospital stay, and one month from discharge date.