title: Chest compression with kneeling posture in hospital cardiopulmonary resuscitation: A randomised crossover simulation study.
abstract: OBJECTIVE
  We suggest an alternative chest compression (CC) in kneeling posture using a 'kneeling stool' on which the performer kneels beside the patient on a bed in-hospital. In kneeling posture, we can maintain high quality cardiopulmonary resuscitation (CPR) without the bed height adjustment, which is necessary and inconvenient in standing posture.
  
  
  METHODS
  This study is a randomised crossover trial with 38 participants working in one ED. The first group knelt on the kneeling stool beside a manikin placed on a bed, whereas the second group stood on a step stool with the manikin at knee level using bed height adjustment. All the participants performed continuous chest compression for 5 min without audio-visual feedback. After that, the posture was changed in each group. The parameters of CC quality (CC depth, rate, accuracy, and incomplete chest recoil), visual analogue scale (VAS) for fatigue and pain, and preference of participants were compared between the two groups.
  
  
  RESULTS
  The data of 33 participants in both postures were analysed following exclusion of five participants. In the comparisons overall and per minute between the two postures, the parameters and VAS do not differ significantly (all P > 0.05) except for the median 1st CC rate that was faster in kneeling posture than in standing posture, P = 0.01). Twenty-three performers preferred the kneeling posture.
  
  
  CONCLUSIONS
  A kneeling posture with a kneeling stool were preferred by participants, which have shown similar results in CC parameters and VAS with a standing posture on a stepstool with bed height adjustment during in-hospital CPR.
authors.affiliation: Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Jaehoon
authors.initials: J
authors.lastname: Oh
authors.forename: Youngjoon
authors.initials: Y
authors.lastname: Chee
authors.forename: Taeho
authors.initials: T
authors.lastname: Lim
authors.forename: Youngsuk
authors.initials: Y
authors.lastname: Cho
authors.forename: In Young
authors.initials: IY
authors.lastname: Kim
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D018592:Cross-Over Studies; D004636:Emergency Service, Hospital; D005221:Fatigue; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008348:Manikins; D010146:Pain; D011187:Posture
keywords: cardiac arrest; cardiopulmonary resuscitation; compression; posture; simulation