A56-13 Manual vs Mechanical Cardiopulmonary Resuscitation (CPR) - A Narrative Review and an Update

Introduction Cardiopulmonary Resuscitation (CPR) is a cornerstone of emergency response to cardiac arrest. Manual CPR has long been the standard, but is limited by provider fatigue and inconsistency. In contrast, mechanical CPR (mCPR) provides consistent and standardized compressions. However, the effectiveness of mCPR remains a subject of debate. Methods In this narrative review, we compare mCPR & manual CPR in out-of-hospital cardiac arrest (OHCA) using a deductive sampling approach. A search strategy was applied using the keywords: mechanical CPR, LUCAS, manual CPR, & out-of-hospital cardiac arrest. Studies published in English from 2010 to 2024 were included. Studies were sourced from national and regional OHCA registries, including the CARES (Cardiac Arrest Registry to Enhance Survival, US), Swedish Cardiopulmonary Resuscitation Registry, German Resuscitation Registry, & Korean regional registries. We excluded trauma, drowning, or pediatric cases. The primary outcome measured was neurologically favorable survival, while secondary outcomes included ROSC, survival to hospital admission, & 30-day survival. Studies reporting ROSC achieved before ACLS arrests were excluded. Results From seven studies (six observational and one meta-analysis) involving 171,166 OHCA patients, we found a mixed set of results. Neurological recovery was generally lower in the mCPR group than in the manual CPR group. CARES registry reported an aOR of 0.74 (95% CI: 0.68-0.81), indicating significantly reduced odds of neurological outcomes with mCPR. Similarly, survival to hospital admission and 30-day survival were also lower in the mCPR group, with aORs of 0.83 and 0.72, respectively. On the contrary, ROSC was either non-significant or slightly higher in the mCPR group. Overall, although our results show a favorable trend for manual CPR in terms of both primary and secondary outcomes, the statistical difference did not reach the threshold of p < 0.05. Conclusions As manual CPR overall demonstrates better long-term neurological outcomes, higher survival rates after hospital admission, and improved 30-day survival, our study highlights the cautious application of mCPR. Further dedicated research is needed to classify patient subgroups and clinical scenarios, enabling the use of mCPR as a standard.