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Comparison of the over-the-head, lateral and alternating positions during cardiopulmonary resuscitation performed by a single rescuer with a bag–valve–mask device
  1. Stefan Maisch,
  2. Eike Gamon,
  3. Alexander Ilisch,
  4. Alwin E Goetz,
  5. Gunter N Schmidt
  1. Department of Anaesthesiology, Universitaetsklinikum Hamburg-Eppendorf, Germany
  1. Correspondence to Stefan Maisch, Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; smaisch{at}


Background The 2005 guidelines for cardiopulmonary resuscitation (CPR) do not include a statement on performance of basic life support by a single healthcare professional using a bag–valve–mask device. Three positions are possible: chest compressions and ventilations from over the head of the casualty (over-the-head CPR), from the side of the casualty (lateral CPR), and chest compressions from the side and ventilations from over the head of the casualty (alternating CPR). The aim of this study was to compare CPR quality of these three positions.

Methods 102 healthcare professionals were randomised to a crossover design and performed a 2-min CPR test on a manikin for each position.

Results The hands-off time over a 2-min interval was not significantly different between over-the-head (median 31 s) and lateral (31 s) CPR, but these compared favourably with alternating CPR (36 s). Over-the-head CPR resulted in significantly more chest compressions (155) compared with lateral (152) and alternating CPR (149); the number of correct chest compressions did not differ significantly (119 vs 122 vs 109). Alternating CPR resulted in significantly less inflations (eight) compared with over-the-head (ten) and lateral CPR (ten). Lateral CPR led to significantly less correct inflations (three) compared with over-the-head (five) and alternating CPR (four).

Conclusions In the case of a single healthcare professional using a bag–valve–mask device, the quality of over-the-head CPR is at least equivalent to lateral, and superior to alternating CPR. Because of the potential difficulties in bag–valve–mask ventilation in the lateral position, the authors recommend over-the-head CPR.

  • Basic life support (BLS)
  • cardiopulmonary resuscitation (CPR)
  • chest compression
  • manikin
  • resuscitation

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  • Funding This study was financed entirely by the Department of Anaesthesiology of the University Hospital Hamburg.

  • Competing interests None.

  • Ethics approval The local ethics committee (Medical Association Hamburg, Germany) declared that such a study did not require ethical approval. All participants gave written informed consent for their CPR performance data to be evaluated.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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