Mechanical chest compression devices in CPR

Should we use mechanical chest compression devices for cardiopulmonary resuscitation (CPR)?

Bernd W. Böttiger: Thank you for this question. According to what Kouwenhoven and Knickerbocker said in their initial publication when they invented modern CPR, published in the Journal of the American Medical Association (JAMA) in 1960, all that is needed is two hands, and all the large-scale studies we have on mechanical chest compression devices show that two hands are at least as effective as any mechanical chest compression device.

Some few studies show very clearly that if we are using mechanical chest compression devices, neurological outcomes after out-of-hospital cardiac arrest are worse than when we use two hands. We do not know the reason for this. One of the speculations is that is takes some time without any chest compression to put the mechanical devices on the patient, and we know that every interruption of chest compressions which is longer than 5 to 10 seconds should be avoided because it is associated with worse neurological outcomes. Therefore, the new guidelines do not recommend mechanical chest compression devices as a routine approach, but we have some estimation that it may be useful during transport to save the people who are doing CPR; it is very difficult to do it in a helicopter or in a driving car, so in this kind of settings mechanical chest compression devices may be useful, as [well as] during a very prolonged period of CRP if you do not have any human resources available anymore or in the percutaneous coronary intervention (PCI) lab where you have X-ray contamination.

So, no routine use, but in some special circumstances it may be useful.