Mechanical versus manual chest compression in cardiac arrest: a systematic review

Background: Early high-quality cardiopulmonary resuscitation (CPR) is crucial for survival following cardiac arrest. To-date, ILCOR has suggested against routine use of mechanical chest compressions, reserving its use for settings where manual compressions are difficult to continue. Due to awareness of new trial data, this review was conducted to inform international treatment recommendations. Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science and the registry platform ClinicalTrials.Gov from inception to 21st October 2025. Only randomised and quasi-randomised controlled trials were included. Critical outcomes of interest were survival with good neurological outcome, survival and quality of life. Important outcomes included ROSC, survival to hospital admission and adverse events. We assessed risk of bias using the Cochrane Risk of Bias-2 tool and evaluated certainty using the GRADE approach. Results: We identified 14 articles reporting results from 11 trials and including a total of 14,565 patients. Substantial methodological and clinical heterogeneity between the studies precluded meta-analysis. The three largest trials (11,291 patients in total), providing low to moderate certainty evidence, all showed no benefit or harm overall from mechanical compressions compared with manual compressions. Lower-certainty evidence from other smaller trials was conflicting, with some showing benefit and some showing harm from a mechanical compression approach. Conclusions: Existing trials do not show a benefit from the use of mechanical compressions, compared with manual compressions. These findings support the current treatment recommendations that advise against the routine use of mechanical chest compression devices.