ABSTRACT
Objective To systematically evaluate the effects of mechanical chest compression (CC) combined with manual CC and single-manual CC on the outcome indexes of cardiopulmonary resuscitation (CPR) for patients with in-hospital cardiac arrest (IHCA). Methods The relevant publicly published literatures about the effects of mechanical CC combined with manual CC and single-manual CC on the outcome of CPR were searched by using the following Chinese keywords for retrieval: "cardiac arrest, asystole, sudden death, artificial recovery, artificial press, artificial CC, unarmed CPR, unarmed resuscitation, unarmed compressions, unarmed chest compressions, unarmed, artificial, resuscitation instrument, resuscitation machine, resuscitator, CPR, LUCAS, Autopulse, Thumper, MSCPR-1A"in databases such as China Biomedical Literature (CBM), VIP, Wanfang, and China National Knowledge Internet (CNKI) from their dates of foundation to March 11, 2019, and using the following key words in English "heart arrest, cardiac arrest, cardiopulmonary arrest, Cardiopulmonary Resuscitation, Resuscitation, Cardio-Pulmonary Resuscitation, CPR, compression, mechanical, automatic, automated, load distributing band, LBD, Autopulse, LUCAS" to retrieve all the published articles especially concerning the topics on the application effects of mechanical combined with manual CC for IHCA patients' CPR in the America National Library database (PubMed), Excerpta Medica (EMbase), Web of Science, and Cochrane Library from the establishment of the databases to March 11, 2019. The indexes of outcomes included return of spontaneous circulation (ROSC) rate, survival rate after hospital discharge and incidence of complications. The literatures were extracted independently by two reviewers, the qualities of the included randomized controlled trials (RCTs) were evaluated according to the Cochrane bias risk assessment tool, and the qualities of the included observational studies were evaluated according to the literature quality assessment form (NOS). Meta analysis was performed by using RevMan 5.3 software, and publication bias was assessed by using funnel plot. Results Twenty-one studies were enrolled, including 11 RCT articles and 10 observational studies; there were 2 005 participants. The results of this Meta-analysis showed that compared with manual CC, the ROSC rate and after discharge survival rate of IHCA patients were obviously higher in combined CC group [ROSC: odds ratio (OR) = 2.50, 95% confidence interval (95%CI) = 2.03-3.09, P < 0.000 01; discharge survival rate: OR = 2.71, 95%CI = 1.91-3.85, P < 0.000 01]; the incidence of complications of combined CC was lower than that in single manual CC (OR = 0.30, 95%CI = 0.13-0.68, P = 0.004). The funnel plots indicated that there was no apparent bias in the ROSC; because the enrolled studies were relatively few, it was difficult to evaluate the symmetrical characteristics of the funnel plots for discharge survival rate and the complication rate. Conclusions For IHCA patients, combined CC can improve ROSC, discharge survival rate, and reduce the occurrence of complications. It is suggested that during the actual rescue of IHCA patients, it is better to use combined CC, that is to say, manual CC should be adopted immediately in the early stage and then replace the mechanical CC device as soon as possible.
ABSTRACT
Objective To comprehensively evaluate and compare the resuscitation efficacy of chest-compression-only cardiopulmonary resuscitation (CCPR) and standard cardiopulmonary resuscitation (SCPR) for patients with out-of-hospital cardiac arrest (OHCA). Methods Databases such as PubMed, Embase, Ovid, Cochrane Library, Wanfang, CNKI, VIP, CBM were searched from the date of their foundation to March 2nd 2018, and the studies on the difference of effects between CCPR and SCPR for patients with OHCA were retrieved. The outcomes included the return of spontaneous circulation (ROSC) rate, survival to hospital discharge, neurological function completion rate. Two reviewers independently screened the literature meeting the inclusion criteria, independently collected information and evaluated the literature quality. Meta-analysis was conducted using RevMan 5.3 software, and sensitivity analysis was conducted by selecting model analysis method and removing single research method. Funnel plot was used to evaluate publication bias. Results A total of 10 cohort studies were included, including 174 163 patients with OHCA, of which 95 157 undergone CCPR and 79 006 undergone SCPR. The scores of the Newcastle-Ottawa scale (NOS) were 8-9, indicating that the quality of the literatures included was high. It was shown by the Meta-analysis that CCPR had the higher rate of survival to hospital discharge [relative risk (RR) = 1.04, 95% confidence interval (95%CI) = 1.00-1.08, P = 0.04] and neurological function completion (RR = 1.11, 95%CI = 1.06-1.17, P < 0.000 1) than SCPR, but there was no significant difference in ROSC rate between the two groups (RR = 1.01, 95%CI = 0.98-1.04, P = 0.52). In the subgroup, there was no statistical significance between CCPR and SCPR in the rate of survival to hospital discharge in cardiac OHCA patients (RR = 1.13, 95%CI = 0.82-1.57, P = 0.45). However, in non-cardiac OHCA group, SCPR showed more benefits than CCPR in improving the rate of survival to hospital discharge (RR = 0.88, 95%CI = 0.80-0.96, P = 0.004). The above analysis results were consistent in the fixed effect model and random effect model, indicating that the results were reliable and stable. It was shown by the funnel plot that most of the studies were left-right inverted funnel type, indicating a low publication bias. However, the bias could not be completely excluded due to the small number of included literatures. Conclusions For patients without OHCA etiological classification, CCPR was not less than SCPR in improving ROSC rate, discharge survival rate and good neurological function, and CCPR was more advantageous in learning and the willingness of bystanders to implement. However, when non-cardiogenic OHCA could be identified, SCPR should be recommended when conditions permit.