• Jakob Mühlbacher, Cordula Pröbstl, Marcus Granegger, Judith Schiefer, Andreas Duma, Michael Hüpfl, Harald Herkner, Michael Röhrich, and Karl Schebesta.
• Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria.
• Pediatr Crit Care Me. 2020 Dec 1; 21 (12): e1076-e1083.

ObjectivesThe primary objective was to determine the impact of infant positioning on cardiopulmonary resuscitation performance during simulated pediatric cardiac arrest.DesignA single-center, prospective, randomized, unblinded manikin study.SettingMedical university-affiliated simulation facility.SubjectsFifty-two first-line professional rescuers (n = 52).InterventionsPerformance of cardiopulmonary resuscitation was determined using an infant manikin model in three different positions (on a table [T], on the provider's forearm with the manikin's head close to the provider's elbow [P], and on the provider's forearm with the manikin's head close to the provider's palm [D]). For the measurement of important cardiopulmonary resuscitation performance variables, a commercially available infant simulator was modified. In a randomized sequence, healthcare professionals performed single-rescuer cardiopulmonary resuscitation for 3 minutes in each position. Performances of chest compression (primary outcome), ventilation, and hands-off time were analyzed using a multilevel regression model.Measurements And Main ResultsMean (± SD) compression depth significantly differed between table and the other two manikin positions (31 ± 2 [T], 29 ± 3 [P], and 29 ± 3 mm [D]; overall p < 0.001; repeated measures design adjusted difference: T vs P, -2 mm [95% CI, -2 to -1 mm]; T vs D, -1 mm [95% CI, -2 to -1 mm]). Secondary outcome variables showed no significant differences.ConclusionsCompressions were significantly deeper in the table group compared to positions on the forearm during cardiopulmonary resuscitation, yet the differences were small and perhaps not clinically important.

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