The effect of hand and body position on chest compression quality and rescuer fatigue in prone cardiopulmonary resuscitation

Aim

This study aimed to compare the quality of compressions in supine cardiopulmonary resuscitation (CPR) and prone CPR by performing chest compressions on a manikin. Evaluating the effect of prone CPR using different hand and body position on the quality of manual chest compressions and fatigue of participants.

Methods

After completing 2 min of chest compression in the supine position (Supine Group), 25 participants randomly performed three sets of 2-minutes chest compressions on a prone position manikin. Stand + hands overlapped Group: participants stood beside the patient bed with their hands overlapped and placed on the posterior segment of the thoracic spine between the scapulae, Straddle + hands separated Group: participants straddled the patient bed with their hands placed above the scapulae on both sides at the mid-chest level, and Straddle + hands overlapped Group: participants straddled the patient bed with their hands overlapping on the posterior segment of the thoracic spine between the scapulae. Subsequently, the quality of chest compressions and participants fatigue were assessed.

Results

Chest compression depth ratio and mean chest compression depth (MCCD) were worse in the three prone CPR groups (Stand + hands overlapped Group: 0.0(0.0,15.6) %, 39.8 ± 1.3 mm; Straddle + hands separated Group: 1.4(0.0,11.7) %, 42.4 ± 1.2 mm; Straddle + hands overlapped Group: 0.0(0.0,9.2) %, 40.9 ± 1.2 mm) than in the Supine group (87.1(68.1,94.0) %; p < 0.001, 52.4 ± 0.4 mm; p < 0.001). In the three prone CPR groups, Straddle + hands separated Group had the greatest MCCD, lowest changes in heart rate (p = 0.018) and lowest changes in RPE scores (p < 0.001). There were no significant differences between the four groups in terms of mean chest compression rate, accurate chest compression rate ratio, or correct recoil ratio.

Conclusion

This simulation-based study showed that the quality of chest compressions was worse in the prone position than in the supine position. When prone chest compressions were performed using different hand and body position, prone CPR performed by a participant straddling a hospital bed with hands placed above the scapula on either side at the mid-chest level provided higher-quality chest compressions and lower rescuer fatigue.