Question – How safe is mechanical CPR compared to manual CPR?

There are two devices used for mechanical CPR – the AutoPulse and LUCAS – neither of which has been demonstrated to show a survival benefit over manual CPR in recent studies (CIRC, LINC, PARAMEDIC). Could these devices be causing more injuries compared to manual compressions? Enter a recently published study from the European Heart Journal.

Koster et al. 2017* was a noninferiority safety study that randomized patients to the Autopulse, Lucas or manual compressions.

Population – patients with either in-hospital cardiac arrest or out-of-hospital cardiac arrest that received manual CPR in the ED. Patients were recruited from Nov 2008-May 2014. Exclusion criteria included traumatic etiology, pediatric patients, patients that already had a mechanical compression device applied by ALS crew, ROSC before application of device.

Intervention – Mechanical CPR

Comparison – Manual CPR

Outcome – serious injuries (visceral organs, large vessels, vertebrae) as assessed blind by post-mortem CT, autopsy or clinical course. These injuries were classified into 3 categories:

  • 1) life-threatening (expected to interfere with cardiac or respiratory function, or exsanguination > 800 mL)
  • 2) serious – injury would require repair or would be expected to prolong hospitalization
  • 3) insignificant

Results: Autopulse (n=115), LUCAS (n=122), Manual Control (n=137)

  • The LUCAS device had similar rates of life-threatening or serious visceral damage compared to manual CPR (7.4% vs 6.3% respectively). There was a trend toward more life-threatening or serious outcomes with the use of the Autopulse (11.7%) but this was not significant. Some of these injuries included pneumothorax, pulmonary contusion, liver rupture, air embolism.
  • 3 patients had death attributable to the resuscitation itself. Two patients with the LUCAS had liver rupture with massive hemorrhage, and there was one AutoPulse patient found to have a tension PTX + air embolism.
  • Most did not survive resuscitation (Autopulse: 62.6%, LUCAS 65.6%, Manual CPR 50.4%), and more of the manual CPR group (49.6%) were admitted to the ICU after resuscitation. The study was underpowered to study survival, so no P values were given.

Conclusions – Mechanical CPR was not more likely to produce significant injuries when compared to manual CPR. There was a trend toward more significant injuries with the use of AutoPulse.

*Primary Author received funding from Physio-Control (Creator of LUCAS) and Zoll-Medical (Creator of AutoPulse).


  1. Koster et. al 2017 – Safety of Mechanical Chest Compression Devices AutoPulse and LUCAS in cardiac arrest: a randomized clinical trial for non-inferiority
June 2024