Effects of sex and clothing on a simulated patient manikin on the hand positioning during chest compressions

• Published in: Journal of Assistive Technology in Physical Therapy Vol. 4; no. 2; pp. 84 - 91
• Main Authors: Kobayashi, Kaoru, Hiiragi, Yukinobu, Kobayashi-Fujita, Wakako
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of Assistive Technologies in Physical Therapy 31.03.2025
• Subjects: Cardiopulmonary resuscitation; chest compressions; clothing influence; manikin simulation; sex differences
• ISSN: 2436-6951
• DOI: 10.57302/jatpt.4.2_84

Effective chest compressions during cardiopulmonary resuscitation (CPR) are critical and influenced by the position of the hand on the chest. The American Heart Association provides general guidelines; however, variations in anatomy, such as sex differences and the presence of clothing, may affect hand placement accuracy. This study aimed to evaluate the effects of sex and clothing on hand positioning during chest compressions using a simulated patient manikin with a focus on addressing potential biases in CPR training and real-world applications. A cross-sectional study design was employed using Resusci-Anne QCPR manikins modified to represent patients with and without breast tissue (BT) and with and without clothing. A total of 122 university students with CPR training participated in this study by marking their hand position on measurement forms under different scenarios. Statistical analysis included χ2 tests for categorical variables. The accuracy of hand positioning varied according to patient sex and clothing status. Marks were more accurate on nude manikins without BT, but showed a tendency to deviate towards the abdomen when with clothing. Hand positioning was most difficult on nude manikins with BT, and participants frequently avoided proper compression points in manikins with BT, especially when clothed, indicating a challenge in identifying appropriate chest compression sites owing to anatomical features and clothing. Sex and clothing influence hand positioning during chest compressions, suggesting the need for CPR training that accommodates these variations to enhance the effectiveness of resuscitation efforts.