Do different mechanical compressors provide equivalent hemodynamic support during cardiopulmonary resuscitation?

Do different mechanical compressors provide equivalent hemodynamic support during cardiopulmonary resuscitation?High-quality chest compression is crucial during cardiopulmonary resuscitation (CPR) to maintain adequate tissue perfusion, ultimately leading to return of spontaneous circulation (ROSC) and favorable neurological outcomes. [1][2]2][3] Mechanical compression devices offer a viable alternative to manual resuscitation, especially in prolonged CPR and/or during transport. 4,5However, the diverse designs and compression techniques of available devices can impact CPR outcomes. [4][5]5][6] A recent retrospective analysis of 2146 out-of-hospital cardiac arrests (OHCA) treated with three different mechanical compressors, i.e.LUCAS (Stryker), Autopulse (ZOLL Medical), and EasyPulse (Schiller), revealed significant differences in ROSC and survival. 6Nevertheless, comparative studies on the devices' performance in terms of hemodynamic support generated, are lacking.The aim of this study was to compare the hemodynamic efficacy of two mechanical compressors, LUCAS and EasyPulse , by assessing end-tidal CO2 (EtCO2) as a surrogate marker 3,7,8 in the OHCAs occurring in Lombardy, Italy, during 2021.More specifically, all available defibrillator records (stored in the Regional database) from patients who underwent mechanical CPR and advanced airway management with continuous EtCO2 monitoring, were included.The first 20 min of CPR were analyzed.The study was approved by the "Milano Area 2" Ethical Committee (no.653_2022bis), and informed consent was waived due to the retrospective observational design.Categorical variables were compared by v2 test, while continuous ones were analyzed with a 2-way ANOVA.A p < 0.05 was considered as statistically significant.Data from 143 OHCAs were analyzed, with 84 cases using LUCAS and 59 using EasyPulse (Fig. 1).No significant differences were found in population and CPR characteristics (including ventilation rate), except for a higher incidence of shockable cardiac arrests in the EasyPulse group compared to the LUCAS one (p < 0.05).Patients compressed with LUCAS exhibited consistently higher EtCO2 levels compared to those compressed with Easy-Pulse (p < 0.001, Fig. 1).This difference was present in both shockable and non-shockable arrests (Fig. 1).A trend towards higher