Sudden cardiac arrest (SCA) is the third leading cause of death in Europe and raises global concern.1 The annual incidence of out-of-hospital cardiac arrest (OHCA) in Europe ranges from 67 to 170 cases per 100,000 inhabitants, with an average survival rate at hospital discharge of 8 %. Meanwhile, the annual incidence of in-hospital cardiac arrest (IHCA) in Europe falls between 1.5 and 2.8 per 1,000 hospital admissions, and the survival rates at 30 days or hospital discharge vary from 15 % to 34 %.1

Prompt and good quality cardiopulmonary resuscitation (CPR) increases the survival of patients with cardiac arrest. European Resuscitation Council (ERC) guidelines recommend a manual chest compression rate of 100-120/min with a chest compression depth of at least 5 cm but no more than 6 cm allowing full chest wall recoil between compressions.2 However, manual CPR is often ineffective as rescuers may experience physical and mental fatigue. Mechanical CPR devices are designed to address this issue, providing an automated approach for high-quality CPR. Among these devices, two are used worldwide: the Lund University Cardiac Assist System (LUCAS) and the AutoPulse. LUCAS device consists of a piston-like mechanism that is placed on the patient's chest and delivers precise and consistent compressions at the recommended depth and rate. Unlike LUCAS, which uses a piston-like mechanism, AutoPulse employs a load-distributing band (LDB) or a band-like device that wraps around the patient's chest and delivers compressions in a more consistent and automated manner.3 While mechanical chest compressions might represent a promising option to alleviate physical strain on medical teams performing CPR, it is important to note that their routine use has not received explicit endorsement in current ERC guidelines.2 Despite the significant interest these devices have generated, their potential role in CPR has not been fully elucidated and their impact on survival and clinical outcome of patients with OHCA and IHCA remains controversial.3, 4, 5, 6, 7, 8, 9

In this scenario, we aimed at summarizing current evidence on mechanical CPR devices with a comprehensive umbrella review.