Ergonomic Considerations in Neonatal Cardiopulmonary Resuscitation: Implications for Practice

Prolonged neonatal cardiopulmonary resuscitation (CPR) is critical for survival in cases of severe bradycardia due to asphyxia. High-performance CPR, emphasizing consistent compression depth and full recoil, improves survival rates.

This pilot study explored how environmental and provider-specific factors-including bed height, positioning, and anthropometry-affect the consistency of neonatal CPR using the 2-thumb technique.

Twenty-two neonatal intensive care unit providers performed 2-minute CPR trials on a neonatal simulator under 2 conditions: self-selected bed height ("choice") and standardized bed height (100 cm, "pre-set"). Compression depth and recoil were recorded using simulator sensors. Postural changes and onset of sway were assessed via video analysis. Results from the head-of-bed position were compared with data from a prior side-of-bed study.

Chest recoil decreased over time in both bed-height conditions, potentially compromising CPR effectiveness. Bed height did not impact the number of postural changes or time to sway with a head-of-bed approach. Compared to the side-of-bed position, head-of-bed placement resulted in fewer postural changes and delayed onset of sway. In the choice condition, taller providers and those with longer reach preferred higher bed heights.

The head-of-bed approach may enhance motor performance by allowing pelvic stabilization against the bed, limiting lower-joint motion, and improving stability. However, this position may impair chest recoil over time, potentially reducing CPR effectiveness. Further research is needed to optimize ergonomic factors influencing neonatal resuscitation performance.