IntroductionEffective resuscitation is a key principle in the management of cardiac arrest. Automated mechanical chest compression devices have been widely adopted to reduce rescuer fatigue and improve the consistency of chest compression. However, chest injuries have been observed following chest compression performed both manually and with mechanical devices.ObjectivesTo compare thoracic and intrathoracic injuries associated with automated mechanical chest compression versus manual chest compression in patients with non-traumatic cardiac arrest.MethodsThis was a prospective open-label controlled study with intended random allocation. Inclusion criteria were patients aged ≥15 years with cardiac arrest who underwent resuscitation in the Emergency Department of Roi Et Hospital between August 1, 2022 and January 1, 2023. Legal guardians or first-degree relatives were invited to provide written informed consent for study participation. Each patient was randomized to receive chest compression by either a rescuer (manual CPR) or an automated mechanical chest compression device. After completion of treatment, all patients underwent chest radiography in anteroposterior (AP) and lateral views.ResultsA total of 66 patients were enrolled: 34 in the mechanical compression group and 32 in the manual compression group. Male patients accounted for 18 (52.94%) and 21 (65.63%) in the mechanical and manual groups, respectively. Injuries were identified in 21 patients in the mechanical group and 7 patients in the manual group (p < 0.001). There were no statistically significant differences in specific injuries, including sternal fracture, rib fracture, pulmonary contusion, and pneumothorax. However, skin bruising was significantly more frequent in the mechanical compression group than in the manual compression group (p < 0.001).ConclusionAutomated mechanical chest compression may be associated with a higher observed rate of thoracic injury, particularly external chest injury, compared with manual chest compression.