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EMS is a field that tends to gravitate toward new and exciting products. One of the most prevalent fields of advancement has been CPR devices. All over the world, EMS agencies are buying these devices at a significant cost, and yet we see no appreciable improvement in outcomes. These devices make it seem like the CPR that is being delivered is superior to hand-on CPR, because after all if a machine is doing the work, it must be good right? But that just doesn’t pan out in the data.

The LINC trial looked at how the LUCAS device works in humans compared to animal models. They found that 4-hour survival of OHCA patients that received hands-on CPR was 23.6% compared 23.7% of patient who received mechanical CPR. 6-month survival was higher in the Hands-on group (8.3% vs. 7.6%) as well [Link]. Additionally, the Zoll Autopulse was evaluated in the CIRC trial. This trial randomized 522 patients in an unblinded study and found that hand-on CPR and CPR using the auto pulse were statistically similar [Link]. To add to the confusion, a 2013 study found that load-distributing bands similar to the Autopulse were statistically more likely to achieve ROSC, but were not necessarily likely to improve outcomes, and concluded “The robustness of these findings should be tested in large randomized clinical trials.” [Link]

So as with most things in science, the answer to the question of “Are CPR devices superior to Hands-On CPR?” may simply be: We don’t know. Right now, it seems that there just isn’t enough data to support fully moving to mechanical CPR. That is not to say, however that there is no place for mechanical CPR devices. There is some evidence to suggest that CPR devices can increase CPR induced consciousness [link], and that prolonged CPR may have a high survivability. A case report was published in 2014 about a 40 year old male that survived after 3.5 hours of CPR [link]. So the jury is out. What is known is that CPR devices are here to stay. Now we just have to figure out how to use them.