title: A comparison between over-the-head and standard cardiopulmonary resuscitation performed by two rescuers: a simulation study.
abstract: BACKGROUND
  In cardiopulmonary resuscitation (CPR) of a patient with an unsecured airway performed by two health care professionals, two methods are possible: 1) Standard CPR according to the guidelines, with one rescuer performing chest compressions from the side and the other rescuer performing ventilations from over the head of the patient. Additional tasks (like attaching the electrocardiogram and defibrillator) must be performed by the second rescuer during the time between ventilations. 2) Over-the-head CPR, with one rescuer performing chest compressions and ventilations from over the head and the other rescuer performing additional tasks.
  
  
  OBJECTIVE
  The aim of this study was to compare the quality of CPR achieved by the two methods.
  
  
  METHODS
  After a standardized theoretical introduction and practical training, 106 medical students with limited knowledge and training in CPR participated in this randomized crossover study. Students performed a 2-min CPR test of standard CPR in both positions and over-the-head CPR alone on a manikin.
  
  
  RESULTS
  Standard CPR led to a significantly shorter hands-off-time over a 2-min interval than over-the-head CPR (median 25 s [interquartile range (IQR) 22-26 s] vs. 38 s [IQR 36-43 s], respectively, p < 0.001), and significantly more chest compressions (167 [IQR 158-176] vs. 142 [IQR 132-150], respectively, p < 0.001), more correct chest compressions (72 [IQR 11-136] vs. 45 [IQR 13-88], respectively, p = 0.004), inflations (10 [IQR 10-10] vs. 8 [IQR 8-8], respectively, p < 0.001), and correct inflations (5 [IQR 2-7] vs. 3 [IQR 1-4], respectively, p < 0.001).
  
  
  CONCLUSIONS
  In the case of a two-professional-rescuer CPR scenario, standard CPR enables a quantitatively better resuscitation than over-the-head CPR.
authors.affiliation: Department of Anaesthesiology, Universitaetsklinikum Hamburg-Eppendorf, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Maisch
authors.forename: Malte
authors.initials: M
authors.lastname: Issleib
authors.forename: Beate
authors.initials: B
authors.lastname: Kuhls
authors.forename: Jakob
authors.initials: J
authors.lastname: Mueller
authors.forename: Tobias
authors.initials: T
authors.lastname: Horlacher
authors.forename: Alwin E
authors.initials: AE
authors.lastname: Goetz
authors.forename: Gunter N
authors.initials: GN
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D011787:Quality of Health Care; D018709:Statistics, Nonparametric; D016896:Treatment Outcome