What are the implications of using a mechanical Cardiopulmonary Resuscitation (CPR) device instead of manual compressions in cardiac arrest?

From the Guidelines

In cardiac arrest situations, manual chest compressions should be initiated immediately, and a mechanical CPR device should be applied as soon as possible without delaying CPR, as emphasized by the American Heart Association guidelines 1.

Key Considerations

• The evidence does not demonstrate a benefit with the use of mechanical piston devices for chest compressions versus manual chest compressions in patients with cardiac arrest, but mechanical devices may be considered in specific settings where high-quality manual compressions are challenging or dangerous for the provider 1.
• Manual chest compressions remain the standard of care for the treatment of cardiac arrest, and mechanical CPR devices like LUCAS or AutoPulse can provide consistent compression depth and rate without rescuer fatigue, making them valuable for prolonged resuscitations, during transport, or in situations with limited personnel 1.
• The transition from manual to mechanical CPR should be coordinated to minimize interruptions, ideally taking less than 10 seconds, and the device should be applied according to manufacturer instructions, ensuring proper positioning over the mid-sternum 1.

Recommendations

• Manual chest compressions should be started immediately in cardiac arrest situations, and a mechanical CPR device should be applied as soon as possible without delaying CPR 1.
• Mechanical CPR devices may be considered in specific settings, such as prolonged CPR, during hypothermic cardiac arrest, in a moving ambulance, or in the angiography suite, provided that rescuers strictly limit interruptions in CPR during deployment and removal of the devices 1.
• Rescuers should be properly trained in the use of mechanical CPR devices and should follow manufacturer instructions for application and use 1.

From the Research

Application of Mechanical CPR Device

• The use of mechanical CPR devices instead of starting manual compression in cardiac arrest is not associated with improved patient outcomes, including return of spontaneous circulation (ROSC) or survival with good neurologic function 2.
• However, mechanical compression devices may be beneficial in select circumstances, such as when there are few rescuers available or during prolonged arrest or transport 2.
• The American Heart Association recommends high-quality chest compressions to optimize coronary and cerebral perfusion pressure, with a compression depth of 5-6 cm at a rate of 100-120 compressions per minute, while allowing the chest to fully recoil between each compression 2.
• Mechanical approaches for CPR are not a replacement for manual compressions, but rather a supplement in specific situations where manual compressions may not be feasible or effective 2.

Benefits and Limitations of Mechanical CPR Devices

• Mechanical CPR devices can provide consistent and high-quality chest compressions, reducing rescuer fatigue and improving guideline adherence 2.
• However, the use of mechanical CPR devices is not without limitations, and their effectiveness is highly dependent on the specific circumstances of the cardiac arrest 2.
• The decision to use a mechanical CPR device should be made on a case-by-case basis, taking into account the availability of rescuers, the duration of the arrest, and the potential benefits and limitations of the device 2.