Impact of the rescuer’s posture and position, or manikin position on the efficacy and efficiency of chest compressions during cardiopulmonary resuscitation in adults: a systematic review

Background: Rescuer posture, position, and patient height during chest compressions (CC) influence its efficacy and efficiency. No clear recommendations exist on these aspects. It is essential to systematize the existing knowledge, especially for nurses and healthcare providers involved in resuscitation. Purpose: To conduct a systematic review about the impact of rescuer posture, position, and manikin/patient height on CC efficacy and efficiency. Methods: The study followed PRISMA guidelines and was registered on PROSPERO. Eligibility criteria included peer-reviewed articles or conference papers comparing different rescuer postures, positions, or manikin/patient heights during CC performed with both hands, regarding efficacy or efficiency. Databases consulted: MEDLINE Complete, SPORTDiscus, Cochrane Reviews, and CINAHL Complete. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies. Results: Of 6539 articles, only 34 met inclusion criteria. All were observational, used manikins, and were classified as weak in global methodological quality. Compared with standing, several studies suggested the kneeling posture may be associated with more effective and efficient CC. Evidence regarding the optimal patient height, including potential anthropometric-based adjustments, remains limited. Findings across the included studies indicated that variations in hand position appeared to have minimal influence on CC quality. Some studies reported decreased CC quality when rescuers performed CC while walking. Conclusions: The available evidence suggested that performing CC while kneeling on a firm surface may be beneficial when feasible. Future research is needed to further evaluate the impact of bed height, self-selected rescuer position, and their relevance to emergency practice.