Mechanical Versus Manual Cardiopulmonary Resuscitation Causing Traumatic Cardiothoracic and Abdominal Injuries: A Meta-Analysis and Systematic Review of Randomized Trials.

BACKGROUND

Mechanical cardiopulmonary resuscitation (CPR) devices are increasingly used during cardiac arrest to provide consistent chest compressions; however, concerns persist regarding their potential to cause traumatic injuries compared with manual CPR.

OBJECTIVES

To compare the cardiothoracic and abdominal injuries caused by mechanical versus manual CPR.

METHODS

A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. MEDLINE, EMBASE, PubMed, and the Cochrane Library were searched up to October 2025 for randomized controlled trials (RCTs) comparing mechanical with manual CPR in adults. Injury outcomes were grouped into clinically relevant categories and analyzed using Review Manager 5.4 with a random-effects model.

RESULTS

Ten RCTs were included. There was no statistically significant difference between mechanical and manual CPR for liver injuries (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 0.47-5.31, Z = 0.75, p = 0.46), rib and sternal fractures (OR 0.99, 95% CI 0.57-1.71; Z = 0.05, p = 0.96), thoracic or pleural injuries (OR: 0.97, 95% CI: 0.80-1.19, Z = 0.28, p = 0.78), or vascular and hemorrhagic complications (OR: 1.02, 95% CI: 0.20-5.13, Z = 0.02, p = 0.98). Subgroup analysis showed no difference for rib fractures or sternal fractures individually.

CONCLUSION

Across all pooled injury categories, mechanical CPR did not demonstrate a significantly different injury profile to manual CPR; however, the low to very low certainty of evidence and absence of any low risk of bias trials mean these findings should be interpreted with caution and do not confirm safety equivalence.