Effect of Bed Height on Chest Compression Quality and Provider Biomechanics During Pediatric CPR Simulation

The Effects of Practitioner Anthropometric Differences and Bed Level on CPR Quality in Pediatric Cardiopulmonary Resuscitation: A Simulation-Based Study

High-quality chest compressions are critical for outcomes after pediatric cardiac arrest, yet rescuer ergonomics and bed height may adversely affect compression quality and fatigue. This randomized crossover simulation study will evaluate how four different bed-height settings influence pediatric CPR quality and rescuer biomechanics. Pediatric emergency medicine residents will perform 2-minute chest-compression-only CPR on a pediatric manikin placed on a hospital bed under four bed-height conditions in randomized order across separate sessions. CPR quality metrics from the manikin's feedback system, rescuer fatigue, physiologic responses, and arm angle over time will be compared to identify an ergonomically optimal bed-height approach.

Study Overview

• Status: Recruiting
• Conditions: In-Hospital Cardiac Arrest; Cardiopulmonary Resuscitation, Simulation Training; Pediatric Cardiac Arrest (Simulated); Rescuer Fatigue During CPR; CPR Quality Assessment; Bed Height in CPR
• Intervention / Treatment: Other: Fixed Standard Bed Height (58 cm); Other: Anthropometry-Based Bed Height (Patella Midpoint); Other: Anthropometry-Based Bed Height (Lower One-Third Patella-ASIS); Other: Self-Selected Bed Height

Detailed Description

Background and Rationale

In-hospital pediatric cardiac arrest requires rapid delivery of high-quality CPR. Compression depth, rate, and full chest recoil are key determinants of effective CPR, but maintaining these targets can be challenging due to rescuer posture, bed height, and fatigue. While step-stool use and provider height have been associated with CPR quality in some contexts, there is limited evidence on how bed-height settings-especially anthropometry-based adjustments-affect pediatric CPR performance and rescuer biomechanics over time.

Objective and Hypothesis

Objective: To determine the effect of four bed-height conditions on pediatric CPR quality and rescuer biomechanics in a controlled simulation setting.

Hypothesis: Anthropometry-based and/or self-selected bed height will improve CPR quality (e.g., correct depth and recoil) and reduce perceived exertion compared with a fixed standard bed height.

Study Design

This is a prospective, randomized, within-subject crossover simulation study. Each participant completes CPR under four bed-height conditions, with the order randomized to reduce learning and fatigue bias. Sessions are performed on separate days.

Participants

Eligible participants are volunteer pediatric emergency medicine residents (or comparable clinicians) who are trained in pediatric basic/advanced life support. Individuals with conditions that could limit safe performance of chest compressions (e.g., significant cardiopulmonary or musculoskeletal disorders) are excluded. Anticipated enrollment is approximately 25 participants.

Interventions (Bed-Height Conditions)

Participants will perform chest-compression-only CPR under four bed-height conditions:

Fixed standard bed height (e.g., 58 cm).

Anthropometry-based height A: bed height aligned to a predefined landmark (e.g., patella midpoint).

Anthropometry-based height B: bed height aligned to a second predefined landmark (e.g., a point derived from the distance between patella and anterior superior iliac spine [ASIS]/spina iliaca anterior superior [SIAS], such as the lower one-third point).

Self-selected height: participant chooses the bed height they feel is optimal.

(Replace the anthropometric definitions above with your exact operational definitions.)

Procedures

A pediatric manikin with objective CPR measurement capability (e.g., Laerdal Little Junior QCPR) is placed on a hospital bed. For each condition, the participant performs 2 minutes of continuous chest compressions as a single rescuer. No metronome and no real-time corrective feedback are provided during the compression period (unless your protocol uses feedback; then adjust this sentence). Standardized hand placement and compression position are instructed.

Outcome Measures

Primary Outcome

Correct Compression Depth (%) during each 2-minute session (manikin-derived).

Secondary Outcomes

Average compression depth (mm)

Average compression rate (compressions/min)

Correct chest recoil / release (%)

Composite CPR quality scores (e.g., compression score, total score), as available from the manikin system

Rescuer fatigue: Borg Rating of Perceived Exertion immediately after each session

Physiologic response: heart rate and oxygen saturation (SpO₂) measured pre- and post-session (and change from baseline)

Rescuer biomechanics: arm/upper-limb angle measured from video at standardized time points during compressions (e.g., 0, 30, 60, 90, 120 seconds)

Statistical Considerations

Outcomes will be compared across bed-height conditions using within-subject methods (e.g., linear mixed-effects models with participant as a random effect). Pairwise comparisons will be adjusted for multiple testing. Exploratory analyses may evaluate whether participant anthropometry (height, BMI, etc.) modifies the effect of bed height on CPR quality.

Ethical Considerations

This is a simulation-based study with no patient involvement and minimal risk. Participants may stop at any time due to discomfort or fatigue. The study has ethics approval from [Akdeniz Üniversitesi Bilimsel Araştırma ve Yayın Etiği Kurulu, Approval Number: 875 /09/28/2025] and all participants provide informed consent.

• Study Type: Interventional
• Enrollment (Estimated): 25
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ömür Akınel, Research Assistant; Phone Number: +905557057390; Email: akinel@gmail.com

Study Locations

• Turkey (Türkiye)
  • Antalya
    • Antalya, Antalya, Turkey (Türkiye), 07020
      • Recruiting
      • Akdeniz University Hospital / Faculty of Medicine Hospital - Dept. of Pediatrics

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age ≥ 18 years
• Pediatric resident/assistant physician working in the Department of Pediatrics (Akdeniz University) with valid ÇİYAD certification
• Willing and able to provide written informed consent
• Able to perform a 2-minute continuous chest-compression CPR cycle on a pediatric manikin
• Available to complete four CPR sessions (each at a different bed-height condition) on separate days

Exclusion Criteria:

• Known chronic cardiopulmonary disease that may limit physical exertion during CPR
• Known musculoskeletal disorder or chronic condition that may affect CPR performance
• Acute injury/illness at the time of participation that could impair safe CPR performance
• Refusal or inability to provide informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Fixed Standard Bed Height (58 cm); Participants perform 2 minutes of single-rescuer, chest-compression-only pediatric CPR on a manikin placed on a hospital bed set to a fixed standard height of 58 cm.	Other: Fixed Standard Bed Height (58 cm); Hospital bed height is set to a fixed standard height of 58 cm for the CPR session.
Experimental: Anthropometry-Based Bed Height (Patella Midpoint); Participants perform 2 minutes of single-rescuer, chest-compression-only pediatric CPR on a manikin with the hospital bed height adjusted to the participant's patella midpoint (knee midpoint) reference.	Other: Anthropometry-Based Bed Height (Patella Midpoint); Hospital bed height is adjusted to the participant's patella midpoint reference before the CPR session.
Experimental: Anthropometry-Based Bed Height (Lower One-Third of Patella-ASIS Distance); Participants perform 2 minutes of single-rescuer, chest-compression-only pediatric CPR on a manikin with the hospital bed height adjusted to the lower one-third point of the distance between the patella and the anterior superior iliac spine (ASIS).	Other: Anthropometry-Based Bed Height (Lower One-Third Patella-ASIS); Hospital bed height is adjusted to the lower one-third point of the distance between the patella and ASIS before the CPR session.
Experimental: Self-Selected Bed Height; Participants perform 2 minutes of single-rescuer, chest-compression-only pediatric CPR on a manikin with the hospital bed height set to the participant's self-selected "most comfortable/optimal" height.	Other: Self-Selected Bed Height; Participant selects the bed height they perceive as optimal/comfortable prior to the CPR session.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correct chest compression depth (%, QCPR-defined)	Percentage of compressions meeting the target depth criteria as calculated by Laerdal Little Junior QCPR manikin sensors. (Recorded separately for each bed-height condition.)	During each 2-minute chest compression-only CPR session (per bed-height condition).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Average chest compression depth (mm)	Mean compression depth (mm) recorded by the QCPR manikin.	During each 2-minute chest compression-only CPR session (per bed-height condition).
Average chest compression rate (compressions/min)	Mean compression rate (compressions/min) recorded by the QCPR manikin.	During each 2-minute chest compression-only CPR session (per bed-height condition).
Correct chest recoil / release (%, QCPR-defined)	ercentage of compressions with complete release (recoil) as calculated by the QCPR manikin.	During each 2-minute chest compression-only CPR session (per bed-height condition).
Perceived exertion (Borg RPE score)	Borg scale score collected verbally at the end of each CPR cycle.	Immediately after each 2-minute CPR session.
Change in heart rate (beats/min)	Post-CPR heart rate minus pre-CPR heart rate measured by pulse oximeter.	From immediately before to immediately after each 2-minute CPR session.
Change in oxygen saturation (SpO2, %)	Post-CPR SpO2 minus pre-CPR SpO2 measured by pulse oximeter.	From immediately before to immediately after each 2-minute CPR session.
Arm angle during CPR (degrees)	Arm/trunk angle measured from standardized video frames captured at 0, 30, 60, 90, and 120 seconds; angle derived via software-based measurement.	During each 2-minute CPR session (0, 30, 60, 90, and 120 seconds).

Collaborators and Investigators

• Sponsor: Akdeniz University

Study record dates

Study Major Dates

• Study Start (Actual): September 28, 2025
• Primary Completion (Estimated): February 1, 2026
• Study Completion (Estimated): April 1, 2026

Study Registration Dates

• First Submitted: December 29, 2025
• First Submitted That Met QC Criteria: December 29, 2025
• First Posted (Actual): January 9, 2026

Study Record Updates

• Last Update Posted (Actual): January 9, 2026
• Last Update Submitted That Met QC Criteria: December 29, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Cardiopulmonary Resuscitation; Rescuer Fatigue; Pediatric Cardiac Arrest; CPR Quality; Bed Height in CPR
• Other Study ID Numbers: AKDENIZ-PEM-OA-001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No