title: Rescuer fatigue and cardiopulmonary resuscitation positions: A randomized controlled crossover trial.
abstract: BACKGROUND
  During cardiopulmonary resuscitation (CPR), it is recommended to alternate rescuers every 2 min when two or more rescuers are available, regardless of the rescuer's position. It is unclear, however, whether rescuer fatigue depends on the rescuer's position.
  
  
  OBJECTIVE
  To compare rescuer fatigue by doing CPR in different positions.
  
  
  METHODS
  This randomized controlled crossover trial studied 24 experienced health-care providers from a teaching hospital in southern Taiwan. Each participant performed CPR for 10 min on days 1, 8, and 15 of the study in three different positions: kneeling, standing on a taboret, and standing on the floor. Effective compression was recorded using the Laerdal Resusci-Anne Skillreporter manikin. The range of motion (ROM) of the elbows and lower back were detected using a flexible goniometer, and the severity of back pain was scored using the Brief Pain Inventory short-form.
  
  
  RESULTS
  Rescuers maintained adequate effective compressions for 2 min while kneeling and standing on a taboret, but only for 1 min while standing on the floor. The ROM for elbows and lower back during CPR while kneeling were significantly lower than for standing on the floor. Moreover, the total pain (p<0.001) and social interference (p=0.004) scores 24h after CPR were significantly lower for the kneeling position.
  
  
  CONCLUSIONS
  CPR is best performed in a kneeling position. In order to minimize rescuer fatigue, we recommend alternating rescuers every 2 min while kneeling or standing on a taboret, and every 1 min while standing on the floor.
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Ning-Ping
authors.initials: NP
authors.lastname: Foo
authors.forename: Jer-Hao
authors.initials: JH
authors.lastname: Chang
authors.forename: Hung-Jung
authors.initials: HJ
authors.lastname: Lin
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
mesh_terms: D000328:Adult; D001416:Back Pain / Q000503:physiopathology; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D018592:Cross-Over Studies; D004550:Elbow / Q000502:physiology; D004632:Emergency Medical Services; D005221:Fatigue / Q000503:physiopathology*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008161:Lumbosacral Region / Q000502:physiology; D008297:Male; D008348:Manikins; D008505:Medical Staff, Hospital; D011187:Posture / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology; D018635:Rescue Work / Q000379:methods*; D013624:Taiwan