Outcomes of Out-of-Hospital Cardiac Arrest (OHCA) and the Role of Mechanical CPR Devices in Emergency Settings: A Systematic Review

resumen

Atef Eid Madkour Elsayed*, Ayat Salah Taha Ismail, Salem Mansour Abokhanjar, Sayyaf Mohammed Alhazmi, Abdullah Abdulrahman Alomran, Mustafa Samir Smaisem, Mohammed Ibrahim Alnakhli, Samar Mohammed Alqahtani, Haifa Salah Aldeen Wagiaallah Salih, Abdulmohsen Aljishi3, Fawaz Mohammed Suliman Almansour4, Roz hamdan alanazi5

Background: Out-of-hospital cardiac arrest (OHCA) remains a leading cause of global mortality, and high-quality chest compressions are essential for patient survival. Mechanical chest compression devices were developed to overcome the limitations of manual cardiopulmonary resuscitation (CPR), but their effectiveness remains debated.

Objectives: This systematic review aimed to evaluate the effectiveness, safety, and clinical outcomes of mechanical versus manual chest compressions in OHCA and selected in-hospital settings. Methods: A systematic search of PubMed, Scopus, Embase, Web of Science, and Cochrane Library was conducted for studies published between 2005 and 2024. Eligible studies included randomized controlled trials, registry analyses, cohort studies, and meta-analyses comparing mechanical and manual chest compressions. Outcomes of interest included return of spontaneous circulation (ROSC), survival to hospital discharge, 30- day survival, neurological outcomes, and adverse events. The study selection process followed PRISMA 2020 guidelines, resulting in 14 studies being included in the final qualitative synthesis

Results: Fifteen studies met inclusion criteria. Randomized trials showed no consistent superiority of mechanical over manual compressions in survival to discharge. However, observational studies and metaanalyses suggested advantages in selected scenarios, including during transport, prolonged resuscitation, and integration into extracorporeal CPR. Mechanical devices demonstrated comparable safety to manual compressions, though some studies reported increased risk of traumatic injuries. Device use was associated with reduced rescuer fatigue and improved consistency of compressions.

Conclusions: Mechanical chest compression devices provide standardized compressions and may offer advantages in specific clinical contexts, but evidence does not support their universal superiority over manual CPR. They should be considered as adjuncts to, rather than replacements for, high-quality manual resuscitation. Further randomized trials are required to define their optimal role in contemporary resuscitation systems.