Mechanical chest compression devices at in-hospital cardiac arrest: A systematic review and meta-analysis

Authors : Keith Couper, Joyce Yeung, Thomas Nicholson, Tom Quinn, Ranjit Lall, Gavin D. Perkins

Abstract

Aim

To summarise the evidence in relation to the routine use of mechanical chest compression devices during resuscitation from in-hospital cardiac arrest.

Methods

We conducted a systematic review of studies which compared the effect of the use of a mechanical chest compression device with manual chest compressions in adults that sustained an in-hospital cardiac arrest. Critical outcomes were survival with good neurological outcome, survival at hospital discharge or 30-days, and short-term survival (ROSC/1-h survival). Important outcomes included physiological outcomes. We synthesised results in a random-effects meta-analysis or narrative synthesis, as appropriate. Evidence quality in relation to each outcome was assessed using the GRADE system.

Data sources

Studies were identified using electronic databases searches (Cochrane Central, MEDLINE, EMBASE, CINAHL), forward and backward citation searching, and review of reference lists of manufacturer documentation.

Results

Eight papers, containing nine studies [689 participants], were included. Three studies were randomised controlled trials. Meta-analyses showed an association between use of mechanical chest compression device and improved hospital or 30-day survival (odds ratio 2.34, 95% CI 1.42–3.85) and short-term survival (odds ratio 2.14, 95% CI 1.11–4.13). There was also evidence of improvements in physiological outcomes. Overall evidence quality in relation to all outcomes was very low.

Conclusions

Mechanical chest compression devices may improve patient outcome, when used at in-hospital cardiac arrest. However, the quality of current evidence is very low. There is a need for randomised trials to evaluate the effect of mechanical chest compression devices on survival for in-hospital cardiac arrest.

Keywords

Cardiac arrest; In-hospital cardiac arrest; Advanced life support; Mechanical chest compression device

Citation: Keith Couper, Joyce Yeung, Thomas Nicholson, Tom Quinn, Ranjit Lall, Gavin D. Perkins Mechanical chest compression devices at in-hospital cardiac arrest: A systematic review and meta-analysis         doi:10.1016/j.resuscitation.2016.03.004

Received: 26 January 2016 Accepted: 7 March 2016 Available online: 11 March 2016

Copyright: © 2016 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Funding

KC and JY are supported as NIHR post-doctoral research fellows. GDP is supported as an Intensive Care Foundation Director of Research and as an NIHR Senior Investigator.

Disclosure

This article/paper/report presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Conflict of interest statement

KC, TQ, RL and GDP have received funding to conduct a feasibility randomised controlled trial of mechanical devices for in-hospital cardiac arrest. The institutions of TQ, RL, and GDP have received funding from the National Institute for Health Research to evaluate the LUCAS-2 chest compression device for out-of-hospital cardiac arrest. GDP is editor for Resuscitation. JY and TN have no conflicts of interest to declare.