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Objective: To compare the rate of injuries during cardiopulmonary resuscitation (CPR) using manual versus mechanical chest compressions with the Lund University Cardiopulmonary Assist System (LUCAS™).
Design: Systematic literature review
Methods: We investigated the use of 2 different CPR methods, manual and mechanical, in order to determine if one was more likely to cause injury in individuals during a cardiac arrest. PubMed searches were conducted using the terms “cardiopulmonary resuscitation,” “adverse effect,” “classification,” “method,” “mortality,” “statistical and numerical data,” “trends,” “complication,” “epidemiology,” and “etiology.” Studies were excluded if they took place before the year 2000, included individuals under 18 years of age, or included living individuals. One hundred forty six studies were found, and after inclusion and exclusion criteria were evaluated, 136 were removed. Four studies were ultimately chosen that were considered most relevant to our research question.
Results: All studies used post-mortem analysis to determine the rate and type of injuries amongst cardiac arrest patients who received manual or mechanical compressions with the LUCAS™ device. Friberg et al evaluated 414 deceased adults. Amongst the control group, 38% had sternal fractures, 77% had rib fractures, and 1.9% had severe soft tissue injuries. The LUCAS™ group showed higher percentages, with 80% sternal fractures, 96% rib fractures, and 10% severe soft tissue injuries. These trends were consistent with Smekal et al and Lardi et al, who both demonstrated a statistically-significant higher number of rib fractures amongst LUCAS™ patients. Lardi C et al (2015) retrospectively examined CPR performed either with the LUCAS™ device or manually. This study emphasized duration of CPR, which was almost twice as long when providers used the LUCAS™ device, when compared to manual compressions. Ondruschka B et al displayed similar results in terms of sternal fractures and rib fractures; however, the study offers the alternative that rib fractures correlate more with a patient's age and CPR duration, rather than the method of compressions performed. While this study found no statistically-significant correlation, an overall higher number of injuries were demonstrated in the LUCAS™ group.
Conclusion: The risk of injuries in CPR when comparing manual compressions to mechanical compressions using the LUCAS™ device demonstrates evidence of increased rates of post-traumatic injury in individuals who were given mechanical compressions.
Bangura M, Spruill M. Injuries in Manual and Mechanical CPR. 2022.
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