title: A comparison between over-the-head and standard cardiopulmonary resuscitation.
abstract: BACKGROUND
  Standard cardiopulmonary resuscitation (CPR) is performed by kneeling adjacent to the side of the casualty. In certain circumstances it may be difficult or impossible to perform CPR in this position, for example in confined spaces such as a narrow corridor, aircraft or train gangway. The aim of this study was to investigate the technique of over-the-head CPR (OTH CPR), where the CPR provider kneels above the casualty and performs chest compressions OTH of the casualty.
  
  
  METHODS
  Twenty volunteers were randomised to a cross over trial where they performed standard and OTH CPR at a 7-day interval. Compression and ventilation variables were recorded on the Laerdal Resusci Annie VAM system.
  
  
  RESULTS
  Chest compression depth and ventilation volume declined over time (0-3 min P < 0.001). There was no difference in compression rate, depth, duty cycle or ventilation rate, inflation rate and ventilation volume between techniques. Hand position was incorrect more frequently in the standard compared to the OTH group (incorrect compressions 300 versus 76, respectively, P < 0.001) due principally to a greater proportion of low positioned compressions in the standard CPR group.
  
  
  CONCLUSIONS
  OTH CPR appears equally effective as standard CPR with some marginal advantages in correct hand placement. We suggest that in situations where it is not possible to perform standard CPR, OTH CPR may be considered as a suitable alternative.
authors.affiliation: Intensive Care Unit, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK. gavin.perkins@virgin.net
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Perkins
authors.forename: Barnaby T F
authors.initials: BT
authors.lastname: Stephenson
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Smith
authors.forename: Fang
authors.initials: F
authors.lastname: Gao
mesh_terms: D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006336:Heart Massage / Q000379:methods*; D006801:Humans; D008020:Life Support Care / Q000379:methods*; D008297:Male; D008348:Manikins; D011187:Posture; D011312:Pressure; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D006113:United Kingdom