According to research, it seems that mechanical compression device is the same as human... But we have to know that:

1° it compares mechanical with highly trained human team using at least 2 people. Do we always have high performing teams in reality?

2° manual compression are done in good conditions were there is for example enough space to move around the patient,...

3° the studies DO NOT compare rcp while moving fro example to the cath lab or to ecmo. And that makes a lot of a difference.

In our HEMS base rcp protocol, we use a mechanical device. First we start manually and we place the device as soon as possible (usually after 8-10 min). Good training in placing the device allow to reduce drastically the waste of time and is mandatory. Than we have 2 more free hands.In our experience the device is really helpful and much better then manual when we decide to MOVE while doing the rcp to avoid loosing time to reach the cath lab or the ecmo team. It is not possible to deliver good manual compression in a moving ambulance and even more in a helicopter. So, we believe, this is where it makes a difference.

I guess none is superior... And both has shown similar outcome.

I feel that it should depend on th availability of Human Resource, the quality of mechanical compression is susceptible

Dear Ho Cheol Kim,

correct to start by manual CPR, but I think the future will be mechanical CPR. I send You attached my old article to increase your doubts!

See also this link on RG: Conference Paper Interposed Abdominal Compression (IAC) CPR: What about the P...

Best Wishes! GFV

According to research, the mechanical is NOT superior to manual. BUT, it is not inferior either. If the team has practiced switching from manual to mechanic (therefore minimizing hands-off times), it is reasonable to switch to mechanic as soon as possible. Experience has shown that it kind of calms the situation, since nobody has to think about who will be doing compressions next.

If the patient is experiencing a recurrent VF, transporting him to PCI should be done sooner than later (providing that the cath lab can do PCI while the patient is still on mechanical CPR). Therefore, once the patient is already on a device, it should be faster. Providing compressions on a moving ambulance (or even cot) is NOT safe or good practice.

I agree with Jukka and Guido. I took part in one of the trials using a Lucas device in the UK - on a strangely egotistical note, there was no significant difference in the quality of CPR or patient outcomes according to the trial measures.... (Yay! - Go Humans!) .....it has raised the question about some other aspects of resus though.

The mechanical devices can be used whilst you carry a patient downstairs or across a field, or into a cath lab. They maintain consistent compressions during transport (and having done that a lot in an ambulance, i can tell you it's a valid consideration); they make life safer for EMS personnel and they free up a pair of hands.

I think that the 'equivocal' trial results are being used to maintain the status quo a little here in the UK - the devices are expensive, need maintenance and without "enough evidence to support their use", it's easier to stick to a traditional model. They also raise the question of when to stop CPR, which is a touchy subject sometimes - or more contentious still, when to start or which groups to use them with. The trial only isolated 1 variable of the resuscitation muddle, so now we need to start looking at more aspects of it.... like the use of adrenaline.

So to answer the question (IMHO) from a UK perspective - Neither is better depending on what criteria you use as a measure, however - their use makes Resuscitation work simpler, safer, more consistent and less resource intensive, but; it opens a can of worms regarding 'appropriate' resuscitation attempts which is a topic that the public interest (here at least) may just not be ready for.

I think that from a resource use and safety point of view, if you have the right reliable device, it won't get tired like we poor old humans do. If your team can swap onto the device as fast as it can swap human operators, then you're saving resources, which makes for a more efficient use of your team.

Many thanks for all the great answers

It depends on the situation. if accurate devise is available, it is better to use the device.

last but not least, in the studies the comparison (machine vs. human) was always based on high-performance manual chest compression. Does your team performing high quality CPR?

From a solid research team in Victoria - AV has some of the best RoSC numbers in OOH in the world. It would appear little difference but it does free up a person.

Article An automated CPR device compared with standard chest compres...

According to research, it seems that mechanical compression device is the same as human... But we have to know that:

1° it compares mechanical with highly trained human team using at least 2 people. Do we always have high performing teams in reality?

2° manual compression are done in good conditions were there is for example enough space to move around the patient,...

3° the studies DO NOT compare rcp while moving fro example to the cath lab or to ecmo. And that makes a lot of a difference.

In our HEMS base rcp protocol, we use a mechanical device. First we start manually and we place the device as soon as possible (usually after 8-10 min). Good training in placing the device allow to reduce drastically the waste of time and is mandatory. Than we have 2 more free hands.In our experience the device is really helpful and much better then manual when we decide to MOVE while doing the rcp to avoid loosing time to reach the cath lab or the ecmo team. It is not possible to deliver good manual compression in a moving ambulance and even more in a helicopter. So, we believe, this is where it makes a difference.

We developed our mechanical CPR protocols in the last years. On our opinion some key points are essential:

1. Embricate mechanical CPR as soon if possible (we do not wait if the device is available immediately)

2. We position immediately at the transition from BLS to ALS phase

3. We spare rescuers energies for patient better transfer

4. Continuous care of device position is a paramount to avoid injures

5. CPR in cramped areas (HEMS) or limited crew is possible (hems crew, we are only two)

6. ETCO2 is the fastest sign of ROSC in a noisy environment (think helicopter or very busy ED)

7.We are publishing (Italian Journal of Emergency Medicine) an accepted case of normothermic cardiac arrest who had ROSC at 52' of mechanical CPR. The VF rhythm had the same amplitude at beginning and at the end of resuscitation. Does it mean that if coronary three is free from obstruction the myocardial cell metabolism is preserved, as well as brain function? Neurologic function of this patient is normal. Previous researches demonstrated a survival with good neurologic outcome probability below 0,4%

8. Please look also to my previous article on mechanical CPR in severe hypothermic patients.

Hope it helps

Manual compressions are as good as mechanical. Of course it always will depend on the milieu and resources. Mechanical compressors have not resulted in better outcomes, even if you ensure that rate and depth are well preserved, probably (that has not been studied) due to time consumed during placemebt and other contraints. On another hand mechanical compressions have been linked to more conplications as rib, spleen, liver o pancreas fractures, less frequent with manual compressions. I think that excepted for some situations as cath lab, transport for organ donation in asistole... etc, well trained rescuers are better.

I agree with the position of the advantages of starting CPR with manual compressions. I have no doubt that the correctly installed device for mechanical compression gives advantages in cases of prolonged and especially non-ergonomic resuscitation.