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. 2025 May 15:24:100984.
doi: 10.1016/j.resplu.2025.100984. eCollection 2025 Jul.

CPR manikin diversity for BLS education: Current status mapped by an international cross-sectional survey and steps to reach health equity

Christoph Veigl  1   2 , Natalie Anderson  3 , Marco Neymayer  1   2 , Sabine Heider  1 , Benedikt Schnaubelt  1 , Andrea Kornfehl  1   2 , Pauline Convocar  4 , Enrico Baldi  5   6 , Jacqueline Eleonora Ek  7 , Rakesh Garg  8 , Zehra' Al-Hilali  9 , Mahmoud Tageldin Mustafa  10 , Mario Krammel  1   11 , Federico Semeraro  12 , Lauren Lai King  13   14 , Robert Greif  15   16 , Sebastian Schnaubelt  1   2   11
Affiliations

CPR manikin diversity for BLS education: Current status mapped by an international cross-sectional survey and steps to reach health equity

Christoph Veigl et al. Resusc Plus. .

Abstract

Background: Certain community groups receive less bystander Basic Life Support (BLS). To improve that it was proposed to include in BLS training manikins representing diverse groups, as in current BLS training most manikins are white, lean and male/flat-chested. However, instructors attitudes about the use of diverse manikins and their distribution worldwide are unclear.

Methods: A cross-sectional survey was distributed in international resuscitation networks and national resuscitation councils. Data from participating organisations and manikin characteristics used for BLS training were analysed, and differences between countries from different income classification were assessed.

Results: After de-duplication and removal of incomplete responses, data of 133 organisations from 43 countries from six continents reporting on 5,364 manikins were analyzed. Most organisations (55%) use only white, male/flat-chested, lean manikins. Non-white manikins were the most commonly used diversification (33% of participating organisations). Only 20% of organisations use female manikins. Greater diversification is thought to enhance realism in training, promote inclusivity, and allows participants to be more aware of real-world situations involving diverse patient populations. Barriers described were high costs, low awareness towards the need of manikin diversity, institutional resistance to changes, and limited evidence on the impact of diversification.

Conclusion: The vast majority of reported adult and pediatric CPR manikins are white, male/flat-chested, and lean, and thus lack diversification. Almost one-fifth of respondents indicated to put a bra on a "standard" manikin to simulate a female manikin. Research into diversified manikin use, how to overcome barriers, and its impact on educational and clinical outcomes are needed.

Keywords: Basic life support; Diversity; Education; Ethnicities; Layperson training; Manikins; Sex.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: “Christoph Veigl is member of the Young European Resuscitation Council (ERC) committee. Jacqueline Eleonora Ek is Chair of the Diversity, Equality, and Inclusion Committee (DEI) of the ERC, Vice-Chair of the Young ERC committee and ERC Advanced Life Support Science and Education Committee (SEC) Young ERC member. Federico Semeraro is the Chair of the ERC, ILCOR BLS Task Force Emeritus member, and a member of the Italian Resuscitation Council Foundation. Robert Greif is Chair of the Task Force Education, Implementation and Team (EIT) of the International Liaison Committee on Resuscitation (ILCOR); ERC Director of Guidelines and ILCOR; and member of the editorial board of Resuscitation Plus. Sebastian Schnaubelt is ILCOR EIT Task Force member, ERC Advanced Life Support Science and Education Committee member, and Vice-Chair of the Austrian Resuscitation Council (ARC)”.

Figures

Fig. 1
Fig. 1
Geographical distribution of the 133 responses included for analysis.
See this image and copyright information in PMC

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