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. 2025 Apr 8;17(2):44.
doi: 10.3390/pediatric17020044.

Optimizing Pediatric Chest Compressions: A Randomized Crossover Simulation Trial of Over-the-Head vs. Lateral Techniques

Malgorzata Kietlinska  1 , Wojciech Wieczorek  2 , Michal Pruc  1 , Lukasz Szarpak  1   3   4 , Grazyna Nowak-Starz  5 , Wojciech Flieger  3 , Burak Katipoglu  6 , Monika Tomaszewska  1
Affiliations

Optimizing Pediatric Chest Compressions: A Randomized Crossover Simulation Trial of Over-the-Head vs. Lateral Techniques

Malgorzata Kietlinska et al. Pediatr Rep. .

Abstract

Background/objectives: Pediatric cardiac arrest poses considerable obstacles, with survival rates markedly inferior to those of adults. Effective chest compressions are essential for enhancing outcomes; nevertheless, the ideal rescuer attitude is still ambiguous. This study sought to compare the efficacy of lateral (LAT) and over-the-head (OTH) chest compression techniques in pediatric cardiopulmonary resuscitation (CPR) and to ascertain whether OTH presents a viable alternative to the conventional LAT method by assessing compression quality, rescuer fatigue, and ergonomics.

Methods: A randomized crossover simulation study was conducted in a high-fidelity medical simulation facility. Thirty-five medical students executed 2 min cycles of chest compressions with both LAT and OTH techniques, interspersed with a 15 min rest period between sessions.

Results: OTH showed a tendency for enhanced overall performance (72.94 vs. 64.46; p = 0.08), while the differences lacked statistical significance. The compression rate was somewhat elevated with OTH (116.94 compared to 114.57; p = 0.31). We assessed LAT as somewhat less challenging (4.37 vs. 3.91; p = 0.17) and found less fatigue (4.83 vs. 4.40; p = 0.24). Male rescuers and individuals with elevated BMI attained larger compression depths. Age was negatively connected with the ease and efficiency of compressions.

Conclusions: Although no statistically significant differences were detected, OTH demonstrated potential for enhanced performance. The anthropometrics of rescuers affected the quality of CPR, highlighting the necessity for tailored training methods. Future investigations should examine the long-term viability of OTH in clinical and pre-hospital environments.

Keywords: cardiopulmonary resuscitation; chest compressions; lateral technique; over-the-head technique; pediatric cardiac arrest; quality; rescuer fatigue; simulation study.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Chest compression techniques: (A) lateral (LAT) position, with the rescuer positioned beside the manikin; (B) over-the-head (OTH) position, with the rescuer over the head of the manikin delivering vertical compressions.
Figure 2
Figure 2
Randomization flow chart.
Figure 3
Figure 3
Chest compression quality among research groups. (Legend: CC = chest compression; LAT = lateral position; OHT = over-the-head position).
Figure 4
Figure 4
Effect of compression on fatigue and pain complaints. (Legend: LAT = lateral position; OHT = over-the-head position).
Figure 5
Figure 5
Heatmap of correlations for compression using lateral position technique.
Figure 6
Figure 6
Heatmap of correlations for compression using over-the-head position technique.
See this image and copyright information in PMC

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