High-quality cardiopulmonary resuscitation (CPR) can restore spontaneous circulation (ROSC) and neurological function and save lives. We conducted an umbrella review, including previously published systematic reviews (SRs), that compared mechanical and manual CPR; after that, we performed a new SR of the original studies that were not included after the last published SR to provide a panoramic view of the existing evidence on the effectiveness of CPR methods. PubMed, EMBASE, and Medline were searched, including English in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) SRs, and comparing mechanical versus manual CPR. A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) and GRADE were used to assess the quality of included SRs/studies. We included both IHCA and OHCA, which compared mechanical and manual CPR. We analyzed at least one of the outcomes of interest, including ROSC, survival to hospital admission, survival to hospital discharge, 30-day survival, and survival to hospital discharge with good neurological function. Furthermore, subgroup analyses were performed for age, gender, initial rhythm, arrest location, and type of CPR devices. We identified 249 potentially relevant records, of which 238 were excluded. Eleven SRs were analyzed in the Umbrella review (January 2014–March 2022). Furthermore, for a new, additional SR, we identified eight eligible studies (not included in any prior SR) for an in-depth analysis between April 1, 2021, and February 15, 2024. The higher chances of using mechanical CPR for male patients were significantly observed in three studies. Two studies showed that younger patients received more mechanical treatment than older patients. However, studies did not comment on the outcomes based on the patient's gender or age. Most SRs and studies were of low to moderate quality. The pooled findings did not show the superiority of mechanical compared to manual CPR except in a few selected subgroups. Given the significant heterogeneity and methodological limitations of the included studies and SRs, our findings do not provide definitive evidence to support the superiority of mechanical CPR over manual CPR. However, mechanical CPR can serve better where high-quality manual CPR cannot be performed in selected situations.

中文翻译：

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机械与手动心肺复苏术 （CPR）：当代系统评价等的总括性回顾


高质量的心肺复苏术 （CPR） 可以恢复自主循环 （ROSC） 和神经功能并挽救生命。我们进行了一项总括性综述，包括先前发表的系统综述 （SRs），比较了机械和手动 CPR;之后，我们对上次发表的 SR 后未包括的原始研究进行了新的 SR，以提供关于 CPR 方法有效性的现有证据的全景视图。检索了 PubMed、EMBASE 和 Medline，包括英语院内 （IHCA） 和院外心脏骤停 （OHCA） SR，并比较了机械与手动 CPR。使用评估系统综述的测量工具 （AMSTAR-2） 和 GRADE 来评估纳入的 SR/研究的质量。我们纳入了 IHCA 和 OHCA，它们比较了机械和手动 CPR。我们分析了至少一项感兴趣的结局，包括 ROSC、入院生存率、出院生存率、30 天生存率和神经功能良好的出院生存率。此外，还对年龄、性别、初始心律、骤停位置和 CPR 设备类型进行了亚组分析。我们确定了 249 条可能相关的记录，其中 238 条被排除在外。在 Umbrella 审查中分析了 11 个 SR（2014 年 1 月至 2022 年 3 月）。此外，对于新的附加 SR，我们确定了 2021 年 4 月 1 日至 2024 年 2 月 15 日期间的 8 项符合条件的研究（未包含在任何先前的 SR 中）进行深入分析。在三项研究中显着观察到男性患者使用机械 CPR 的机会更高。两项研究表明，年轻患者比老年患者接受更多的机械治疗。然而，研究没有根据患者的性别或年龄对结局进行评论。 大多数 SR 和研究的质量为低到中等。合并的结果没有显示机械 CPR 与手动 CPR 相比的优越性，除了在少数选定的亚组中。鉴于纳入研究和 SR 的显着异质性和方法学局限性，我们的研究结果并未提供明确的证据来支持机械 CPR 优于手动 CPR。但是，在选定情况下无法执行高质量的手动 CPR 时，机械 CPR 可以更好地发挥作用。