Evidence for Mechanical CPR in Hospital Settings
Mechanical CPR devices should not be used routinely in hospital cardiac arrest but may be considered in specific situations where manual CPR is difficult or impossible to maintain. 1
Current Recommendations for Mechanical CPR
General Use in Hospital Settings
- Manual chest compressions remain the standard of care for in-hospital cardiac arrest treatment 1
- There is insufficient evidence to recommend the routine use of mechanical CPR devices over manual chest compressions in hospital settings 1
- Load-distributing band (LDB) CPR devices may be considered for use by properly trained personnel in specific settings, but not for routine use 1
Specific Situations Where Mechanical CPR May Be Beneficial
- Mechanical CPR devices may be considered in circumstances that make manual resuscitation difficult, such as during diagnostic and interventional procedures 1
- These devices can be useful during procedures like percutaneous coronary intervention (PCI) or computed tomography (CT) scans 1
- Mechanical devices may allow for continued high-quality compressions in situations where provider fatigue or safety would compromise manual CPR quality 2
- Mechanical CPR may be considered when the delivery of high-quality manual compressions is challenging or dangerous for providers 1
Evidence Quality and Outcomes
Out-of-Hospital Evidence
- Large randomized controlled trials in out-of-hospital settings have not shown improved survival with mechanical CPR devices:
In-Hospital Evidence
- Limited high-quality data exists specifically for in-hospital use of mechanical CPR devices 4
- Some observational studies report favorable outcomes with mechanical devices in special circumstances 2
- A systematic review of in-hospital mechanical CPR reported a 39% survival rate, though this may be influenced by publication bias 4
Device Types and Considerations
Types of Mechanical CPR Devices
- Piston devices (like LUCAS): Gas or electric-powered devices that produce consistent chest compression rate and depth 1
- Load-distributing band (LDB) devices (like AutoPulse): Circumferential chest compression devices with pneumatically or electrically actuated constricting bands 1
Implementation Considerations
- Proper training of personnel is essential for effective use of any mechanical CPR device 1
- Rescuers should limit interruptions in CPR during device deployment 1
- Mechanical devices should be programmed to deliver high-quality CPR with:
- Adequate compression depth of at least 2 inches (5 cm)
- Rate of at least 100 compressions per minute
- Compression duration of approximately 50% of the cycle length 1
Special Circumstances
During Procedures and Transport
- Mechanical CPR can provide consistent compressions during procedures like coronary angiography 1
- These devices may be useful during patient transport when manual CPR would be difficult to maintain 5
- The feasibility of using mechanical CPR devices during PCI has been demonstrated in both animal and human studies 1
Bridge to Advanced Therapies
- Mechanical CPR may serve as a bridge to advanced therapies such as extracorporeal membrane oxygenation (ECMO) 2
- In settings where ECPR is readily available, mechanical CPR may help maintain circulation until ECPR can be initiated 1
Potential Risks and Limitations
- Deployment of mechanical devices may cause interruptions in chest compressions 1
- Some studies have raised concerns about possible harm with certain devices 1
- One multicenter randomized controlled trial comparing LDB-CPR to manual CPR demonstrated worse neurologic outcomes with the device 1
- Clinical adverse events reported with mechanical devices include chest bruising, chest lacerations, and blood in mouth 3
Conclusion
While mechanical CPR devices can deliver consistent high-quality compressions, current evidence does not support their routine use in hospital settings. They should be considered primarily for specific situations where manual CPR is difficult to maintain or as a bridge to advanced therapies.