Manual CPR may be better for patients

9th January 2017

Manual CPR may provide better survival for people who have an out-of-hospital cardiac arrest than mechanical external defibrillators.

That is the finding of new research in America published in Circulation online last month. It suggested that use of external devices was associated with less favourable outcomes for patients.

The use of external defibrillators in public places has become more widespread, though survival benefits have not been demonstrated in trials, wrote Dr Joseph Rossano from the Children’s Hospital of Philadelphia and colleagues.

To investigate, the team analysed registry data from 2013 to 2015 on 80,861 people who experienced out-of-hospital cardiac arrests, just over one third of whom received CPR from a bystander.

Researchers compared outcomes for the 17,625 treated with a mechanical device and with the 63,056 receiving manual CPR only.

Overall survival and neurologically favourable survival were greatest in patients who did not receive mechanical resuscitation

The key finding, Dr. Rossano said, was that the use of the external devices was associated with worse overall survival and (worse) neurologically favourable survival at hospital discharge.

Dr Christopher Granger of Duke University in Durham, North Carolina, coauthor of an article on improving out-of-hospital cardiac arrest care in the same issue of Circulation, said: "This study shows that use of a device that is widely used across the US to provide mechanical CPR to patients in cardiac arrest was associated with worse outcomes, but it may have been because those patients were sicker.

“The study suggests we should not be enthusiastic about investing in these devices, unless additional studies show some benefit."

Dr Ashish Panchal, director of the centre for emergency medical services at The Ohio State University Wexner Medical Centre in Columbus, said: "This study highlights that real-world implementation is different from randomised, controlled trials. We should take caution that (this) device does not necessarily improve outcomes. But the use of these tools in conjunction with excellent training, optimised CPR performance, and continuous process improvement can improve outcomes from cardiac arrest."

For more details, see here