Comparison of Over-the-Head and Standard Lateral Cardiopulmonary Resuscitation: A Prospective Crossover Simulation Study.

BACKGROUND

High-quality cardiopulmonary resuscitation (CPR) is fundamental to survival. Standard training emphasizes the lateral position, but confined spaces (e.g., airplane aisles, ambulances, narrow hallways) often necessitate the over-the-head (OTH) technique. The effect of this position on compression biomechanics remains unclear.

STUDY

OBJECTIVES

To compare OTH and standard lateral CPR techniques in a manikin simulation regarding the quality of chest compression and rescuer fatigue.

METHODS

This prospective, crossover simulation study included 45 experienced health care professionals. Participants performed 2 min of continuous chest compressions in both lateral and OTH positions, separated by a 24-h washout period. Compression depth, rate, and fraction were recorded using a CPR feedback-capable defibrillator, with real-time audiovisual feedback disabled during data collection. Fatigue was assessed using a numeric rating scale.

RESULTS

A total of 41 participants completed the protocol. The mean compression rate (121.7 vs. 120.5/min, p = 0.306) and mean depth (49.5 vs. 49.5 mm, p = 0.897) were similar between the OTH and lateral positions, indicating comparable average depth adequacy. However, reflecting lower consistency, the percentage of compressions within the target depth range (50-60 mm) was considerably lower in the OTH position (35.2% vs. 49.4%, p = 0.027). Self-reported fatigue scores did not differ considerably (2.5 vs. 2.8, p = 0.132).

CONCLUSION

Although OTH CPR achieved a similar average depth and rate to the lateral position, it resulted in a lower proportion of compressions within the optimal depth range. Therefore, OTH CPR seems to be a feasible situational alternative in confined environments when lateral access is limited. Dedicated training may be needed to optimize depth in the OTH position. © 2026 Elsevier Inc.