Manual Versus Mechanical Cardiopulmonary Resuscitation Complications After Successful Resuscitation for Out-of-Hospital Cardiac Arrest

Document Type

Conference Proceeding

Publication Date


Publication Title

Annals of Emergency Medicine


Objectives: Mechanical cardiopulmonary resuscitation (CPR) is increasingly being used for field out of hospital cardiac arrest (OHCA) care. However, existing literature does not identify a survival benefit of mechanical versus manual CPR. We hypothesized the CPR-related injury may impact patient outcomes. For that reason, our primary objective in this study is to compare rates of field mechanical and manual CPR-related injury in patients resuscitated from OHCA. Our secondary objective is to compare hospital outcomes including length of stay and survival between these two CPR methods. Methods: We performed a retrospective study of adult OHCA patients admitted to three teaching hospitals in Southeastern Michigan from 2017-2021. Patients from the CARES registry were matched to hospital electronic medical records (EMRs), included if they had CT imaging of chest or abdomen/pelvis, and then dichotomized based on CPR method. Patients were excluded if unable to match with hospital EMR or CPR method was unknown. Hospital EMRs were queried for CT imaging results, hospital, and ICU length of stay (LOS), mechanical ventilation duration, and survival to hospital discharge. Injuries are identified using hospital ICD-10 codes. Univariate statistics using means and proportions are reported. Results: There were 808 cardiac arrest records admitted after OHCA, with 235 patients (103 mechanical CPR, 132 manual CPR) meeting the inclusion criteria. Demographics between groups were similar in age, gender, or body mass index (BMI). Any CPR associated injury was more common in patients with manual CPR identified in (28.8% vs 15.5%, p¼0.02). No abdominal visceral injuries and few (4) had a pneumothorax. Manual CPR was associated with an increased rate of rib(s), sternum, or thoracic spine fracture (27.3% vs 14.6%, p¼0.02). We identified no difference in median hospital LOS and ICU LOS, and ventilator time between groups (see table) but are underpowered to detect meaningful differences. We also identified no differences in survival to hospital discharge (39 (29.5%) vs. 29 (28.2%), p¼0.8). Conclusions: We identified a higher rate of injury with manual CPR compared to mechanical CPR. We also did not identify any association between CPR method and ICU LOS, ventilator time, and hospital outcomes overall. Further work is needed to assess impact of CPR method and injuries typically associated with resuscitation.




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American College of Emergency Physicians ACEP Research Forum, October 9-12, 2023, Philadelphia, PA