ABSTRACTBackground Mechanical cardiopulmonary resuscitation (CPR) devices are increasingly used during cardiac arrest to provide consistent chest compressions; however, concerns persist regarding their potential to cause traumatic injuries compared with manual CPR. Objectives To compare the cardiothoracic and abdominal injuries caused by mechanical versus manual CPR. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. MEDLINE, EMBASE, PubMed, and the Cochrane Library were searched up to October 2025 for randomised controlled trials (RCTs) comparing mechanical with manual CPR in adults. Injury outcomes were grouped into clinically relevant categories and analysed using Review Manager 5.4 with a random-effects model. Results Ten RCTs were included. There was no statistically significant difference between mechanical and manual CPR for liver injuries (OR: 1.59, 95% CI: 0.47–5.31, Z = 0.75, P = 0.46), rib and sternal fractures (OR 0.99, 95% CI 0.57–1.71; Z = 0.05, P = 0.96), thoracic or pleural injuries (OR: 0.97, 95% CI: 0.80–1.19, Z = 0.28, P = 0.78), or vascular and haemorrhagic complications (OR: 1.02, 95% CI: 0.20–5.13, Z = 0.02, P = 0.98). Subgroup analysis showed no difference for rib fractures or sternal fractures individually. Conclusion Across all pooled injury categories, mechanical CPR did not demonstrate a significantly different injury profile to manual CPR; however, the low to very low certainty of evidence and absence of any low risk of bias trials mean these findings should be interpreted with caution and do not confirm safety equivalence.
El-Tahlawy et al. (Fri,) studied this question.