Introduction The 2010 International Liaison Committee on Resuscitation gave a detailed update on best practice for cardiopulmonary resuscitation (CPR) with a discussion on appropriate patient and CPR provider position, based largely on expert opinion. The objective of this study was to ascertain robust evidence on the effect of bed height and fatigue on chest compression effectiveness.

Methods A modified Laerdal manikin was connected to a Dragor ventilator (to measure intrathoracic pressures generated). The manikin was placed on a hospital trolley and CPR was performed by candidates at three different bed heights in a randomised order: (1) mid-thigh, (2) anterior superior iliac spine and (3) xiphisternum. Chest compressions were continuous and asynchronous with ventilation, and were allowed to continue for 30 s before recordings were taken. At the anterior superior iliac spine level, chest compressions were continued for 2 min, when further measurements were taken.

Results 101 subjects took part. The differences in intrathoracic pressures generated at different bed heights were compared using analysis of variance testing for multiple groups and were statistically significant for p<0.05. The authors also found that the effectiveness of CPR decreased 17% over a 2-minute period (p<0.05).

Conclusions The most effective bed height position, allowing CPR providers to achieve the highest intrathoracic pressures during CPR, was one where the patient's chest was in line with the CPR provider's mid-thigh. The provider performing CPR should change every 2 min.