Effects of forward-leaning cardiopulmonary resuscitation on chest compression quality and rescuer fatigue

Guided by the 2020 AHA quality targets for chest compressions, we used a manikin model to assess the effects of compression angle (90° vs. 100°) and audiovisual feedback on compression quality and rescuer fatigue.

This was a randomised, crossover, controlled trial. Four experimental groups were included: CCA90°, CCA90° with audiovisual feedback, CCA100°, and CCA100° with audiovisual feedback. Twenty-nine participants, following standardized training, performed 2-minute chest compression sessions on a manikin under each condition, with the order of scenarios randomized by lottery. Heart rate, blood pressure, and Borg Rating of Perceived Exertion (RPE) were recorded immediately before and after each session.

Significant differences in mean chest compression depth were observed among the four groups (CCA90°: 49.6 ± 7.6 mm; CCA90° with audiovisual feedback: 51.3 ± 3.2 mm; CCA100°: 50.7 ± 8.3 mm; CCA100° with audiovisual feedback: 55.1 ± 4.5 mm; P < 0.001). However, both the CCA100° and CCA100° with audiovisual feedback groups had comparable medians (100%) but a lower overall distribution for Correct recoil rate (100 [92.8, 100]% and 98.5 [74.3, 100]%, respectively; P < 0.001) and for Correct hand position ratio (91.9 [23.7, 99.4]% and 89.1 [59.5, 99.8]%,respectively; P < 0.001) compared to the conventional CCA90° group. Changes in heart rate (P = 0.02) and RPE scores (P < 0.001) were greatest in the CCA100° with audiovisual feedback group, indicating a higher level of rescuer fatigue. No significant differences were observed among the four groups in terms of mean chest compression rate, accurate compression rate ratio, or change in mean arterial pressure.

The forward-leaning (100°) posture during CPR enhances chest compression depth; however, it may compromise correct hand positioning and complete chest recoil.