Thoracic Injury in Chest Compression: A Meta-Analysis and Preclinical Evaluation of a Self-Developed Flexible Wearable Assist Device
DOI:
https://doi.org/10.70088/x3ba7j18Keywords:
Cardiopulmonary resuscitation, Mechanical chest compression, Thoracic injury, Meta-analysis, Animal experiment, Flexible wearable chest compression assist deviceAbstract
To systematically evaluate the difference in thoracic injury risk between mechanical and manual chest compressions in adults with cardiac arrest, and to preliminarily observe the trend of soft-tissue and visceral organ injury associated with a flexible liquid silicone-based wearable chest compression assist device in a porcine ventricular fibrillation model. In accordance with the PRISMA 2020 guidelines, PubMed, Embase, and the Cochrane Library were systematically searched from inception to June 20, 2026. Literature screening and data extraction were performed independently by two reviewers; a random-effects model was employed for meta-analysis. Concurrently, eight Bama miniature pigs were randomized into a manual chest compression group (n=4) and a flexible wearable chest compression assist device group (n=4). A ventricular fibrillation-induced cardiac arrest model was established, and injury severity was scored using a modified Post-Resuscitation Damage Assessment (PRDA) scale. Intergroup comparisons were subjected to descriptive trend analysis only. A total of 12 independent studies enrolling 3,546 patients were included in the meta-analysis. The overall incidence of compression-related injury was significantly higher in the mechanical chest compression group than in the manual group, with a pooled odds ratio (OR) of 2.36 (95% confidence interval [CI]: 1.09--5.09), an absolute risk increase of 12.58%, and a number needed to harm (NNH) of 8 (95% CI: 6--64). For secondary outcomes, an elevated risk of rib fracture was observed in the mechanical group (pooled OR 2.13, 95% CI: 1.41--3.23; absolute risk increase 16.56%), as was an elevated risk of hemothorax (pooled OR 2.25, 95% CI: 1.29--3.93; absolute risk increase 7.02%). In the animal experiment, the overall injury scores were comparable between the two groups (manual group 3.50±1.29 versus device group 3.75±0.96); neither pneumothorax, rib fracture, nor sternal fracture was observed in either group. The incidence of focal skin injury was higher in the device group (50%) than in the manual group (25%). The median scores for hemothorax and bronchial hemorrhage were slightly higher in the device group, whereas gastric hemorrhage was lower. Commercially available rigid mechanical chest compression confers a higher risk of thoracic injury than manual compression; individualized risk-benefit assessment is warranted in clinical practice. No significant amplification of severe injury risk was observed with the self-developed flexible device; however, its biomechanical safety advantages remain to be further validated in large-sample animal models with osteoporotic characteristics and subsequent preclinical studies.References
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Copyright (c) 2026 Landan Xiao, Wenwen Ma, Chen Zhang, Enze Liu, Xingxin Deng, Huisheng Deng (Author)
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