Comparison of Quality and Rescuer Fatigue Between Mechanical and Manual Chest Compressions in a Simulated In-Hospital Cardiac Arrest Scenario: A High-Fidelity Simulation Randomized Crossover Controlled Study

Background High-quality cardiopulmonary resuscitation (CPR) is fundamental to improving outcomes in cardiac arrest. This study aimed to comprehensively compare the quality of mechanical versus manual chest compressions in defibrillable and non-defibrillable rhythms within a simulated in-hospital cardiac arrest setting, and to quantify rescuer fatigue using high-fidelity simulation. Method A prospective, randomized, crossover, controlled study was conducted. Sixty healthcare providers holding valid advanced life support certification were organized into 20 three-member teams (each comprising one physician and two nurses). Each team performed four 15-minute simulated in-hospital cardiac arrest scenarios in random sequence: (1) manual compressions with non-defibrillable rhythm; (2) manual compressions with defibrillable rhythm (ventricular fibrillation/pulseless ventricular tachycardia); (3) mechanical compressions with non-defibrillable rhythm; and (4) mechanical compressions with defibrillable rhythm. A washout period of at least 3 days was maintained between scenarios. Scenarios were conducted using a high-fidelity patient simulator capable of real-time recording and feedback of CPR quality metrics. Primary outcomes included chest compression depth (CCD), chest compression rate (CCR), proportion of correct compression depth (PCCD), chest compression recoil rate (CCRR), proportion of correct compression rate (PCCR), chest compression fraction (CCF), rescuer fatigue score (RFP), and overall compression quality (CCQ). Data were analyzed using repeated-measures analysis of variance. Results (1) Regardless of whether defibrillation or not, with the increase of compression time, the quality of manual compression decreased, the compression frequency increased, and the fatigue value gradually increased. However, in the mechanical compression group, with the increase of compression time, the quality of compression did not change significantly;(2) The data dispersion of compression depth and compression frequency in the artificial cardiopulmonary resuscitation group was higher than that in the mechanical cardiopulmonary resuscitation group;(3) In the three stages of simulation, there were significant differences in the quality indicators of manual compression among the groups with the increase of compression time. The compression depth and chest rebound showed a downward trend, while the compression rate and the fatigue value of rescuers showed an upward trend;(4) In the three stages of simulation, except for the first stage, with the increase of compression time, the quality indicators and fatigue values of artificial cardiopulmonary resuscitation were significantly different from those of mechanical cardiopulmonary resuscitation. Conclusion In the simulation scenario of in-hospital CPR, mechanical CPR has better compression quality and stability than manual CPR, and can reduce the fatigue value of rescuers.