Hand Position, CPR Quality and Rescuer Comfort

Effect of Hand Position During Chest Compressions on Resuscitation Quality and Rescuer Comfort: A Randomized Crossover Simulation Study

This randomized crossover simulation study will compare two hand positions used during chest compressions: interlocked fingers and non-interlocked hands placed one on top of the other. The study will evaluate whether the non-interlocked hand position is non-inferior to the interlocked-finger technique with regard to chest compression depth, and will compare the two techniques in terms of CPR quality, rescuer comfort, fatigue, pain or discomfort, and perceived hand-position stability.

Study Overview

• Status: Recruiting
• Conditions: Cardiac Arrest (CA)
• Intervention / Treatment: Behavioral: Interlocked-finger chest compression technique; Behavioral: Overlapped hands chest compression technique

Detailed Description

High-quality chest compressions are a key component of cardiopulmonary resuscitation (CPR). Current international resuscitation guidelines recommend placing one hand on top of the other during chest compressions, but recommendations regarding whether the fingers should be interlocked or simply placed on top of each other are based on limited scientific evidence.

This prospective, randomized, controlled crossover simulation study will compare two hand positions during continuous chest compressions on an adult CPR manikin. Each participant will perform two 2-minute chest compression periods, using both techniques in a computer-randomized order: (1) interlocked fingers, representing the commonly taught technique, and (2) non-interlocked hands placed one on top of the other. A 10-minute seated rest period will separate the two measurement periods.

The primary outcome will be mean chest compression depth. Secondary outcomes will include compression rate, proportion of compressions with adequate depth and full chest recoil, temporal changes in compression depth, and subjective assessments of pain, discomfort, physical fatigue, hand-position stability, and confidence in performing chest compressions. Participants will also indicate which technique they would prefer in a real resuscitation situation.

The study will be conducted in a simulation environment at the Human Patient Simulation Center of the University of Pécs Faculty of Health Sciences. Participants will not receive real-time feedback from the manikin during the measurements.

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Bálint Bánfai, PhD; Phone Number: +3672501-500; Email: balint.banfai@etk.pte.hu

Study Locations

• Hungary
  • Pécs, Hungary, 7621
    • Recruiting
    • University of Pecs
    • Contact: Bálint Bánfai, PhD; Phone Number: +3672501-500; Email: balint.banfai@etk.pte.hu

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Adults aged 18 years or older
• Healthcare professionals or laypersons
• Physically able to perform chest compressions
• Able and willing to provide written informed consent to participate in the study

Exclusion Criteria:

• Acute injury of the upper extremities
• Chronic musculoskeletal disease or symptoms that may interfere with the ability to perform chest compressions with adequate quality
• technical issue during data collection

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Interlocked fingers; Participants will perform continuous chest compressions using the interlocked-finger hand position. One hand will be placed on the lower half of the sternum, with the other hand placed on top and the fingers interlocked. Chest compressions will be performed for 2 minutes according to current international CPR recommendations, targeting a compression depth of 5-6 cm, a rate of 100-120 compressions per minute, and complete chest recoil after each compression. No real-time feedback from the manikin will be provided during the measurement.	Behavioral: Interlocked-finger chest compression technique; Participants will perform chest compressions using the interlocked-finger hand position. One hand will be placed on the lower half of the sternum and the other hand on top, with the fingers interlocked. The intervention will consist of 2 minutes of continuous chest compressions performed at a target rate of 100-120 compressions per minute and a target depth of 5-6 cm, with complete chest recoil after each compression. No real-time feedback will be provided.
Active Comparator: Overlapped hands; Participants will perform continuous chest compressions using the non-interlocked hand position. One hand will be placed on the lower half of the sternum, with the other hand placed directly on top without interlocking the fingers. Finger contact between the two hands will be permitted, but active interlocking will not be performed. Chest compressions will be performed for 2 minutes under the same conditions as the interlocked-finger condition, targeting a compression depth of 5-6 cm, a rate of 100-120 compressions per minute, and complete chest recoil after each compression. No real-time feedback from the manikin will be provided during the measurement.	Behavioral: Overlapped hands chest compression technique; Participants will perform chest compressions using the non-interlocked hand position. One hand will be placed on the lower half of the sternum and the other hand on top without interlocking the fingers. The intervention will consist of 2 minutes of continuous chest compressions performed under the same conditions as the interlocked-finger technique, with a target rate of 100-120 compressions per minute, a target depth of 5-6 cm, and complete chest recoil after each compression. No real-time feedback will be provided.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean chest compression depth (mm)	Mean chest compression depth recorded continuously by the manikin's integrated measurement system during CPR performance.	During procedure.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chest compression rate (per minute)	Mean chest compression rate (compressions per minute) recorded by the manikin's integrated measurement system during CPR performance.	During procedure.
Proportion of compressions with adequate depth (%)	Proportion of chest compressions meeting the predefined target depth, as recorded by the manikin's integrated measurement system.	During procedure.
Proportion of compressions with complete chest recoil (%)	Proportion of chest compressions followed by complete chest recoil, as recorded by the manikin's integrated measurement system.	During procedure.
Interruption duration (sec)	Duration of interruptions in chest compressions (hand-off time), if applicable, recorded by the manikin's integrated measurement system.	During procedure.
Overall chest compression quality score (points, mean, SD)	Overall chest compression quality score calculated by the manikin's integrated measurement system based on predefined CPR performance parameters.	During procedure.
Self-reported hand pain	Participants' self-reported overall hand pain following CPR performance, assessed using a 0-10 Numeric Rating Scale, where 0 indicates no pain and 10 indicates the worst imaginable pain.	Immediately after the CPR procedure (within 15 minutes)
Finger discomfort	Participants' self-reported discomfort in the fingers following CPR performance, assessed using a 0-10 Numeric Rating Scale.	Immediately after the CPR procedure (within 15 minutes)
Wrist discomfort	Participants' self-reported wrist discomfort following CPR performance, assessed using a 0-10 Numeric Rating Scale.	Immediately after the CPR procedure (within 15 minutes)
Perceived physical fatigue	Participants' self-reported physical fatigue following CPR performance, assessed using a 0-10 Numeric Rating Scale.	Immediately after the CPR procedure (within 15 minutes)
Perceived hand-position stability	Participants' perceived stability of their hand position during CPR performance, assessed using a 0-10 Numeric Rating Scale.	Immediately after the CPR procedure (within 15 minutes)
Perceived hand slippage	Participants' perceived sensation of hand slippage during CPR performance, assessed using a 0-10 Numeric Rating Scale.	Immediately after the CPR procedure (within 15 minutes)
Preferred hand position	Participants' preferred hand position for performing CPR in a real-life cardiac arrest situation.	Immediately after the CPR procedure (within 15 minutes)

Collaborators and Investigators

• Sponsor: University of Pecs
• Investigators: Principal Investigator: Bálint Bánfai, PhD, University of Pécs Faculty of Health Sciences

Study record dates

Study Major Dates

• Study Start (Estimated): October 15, 2026
• Primary Completion (Estimated): February 15, 2027
• Study Completion (Estimated): March 15, 2027

Study Registration Dates

• First Submitted: September 11, 2026
• First Submitted That Met QC Criteria: September 11, 2026
• First Posted (Actual): September 17, 2026

Study Record Updates

• Last Update Posted (Actual): September 17, 2026
• Last Update Submitted That Met QC Criteria: September 11, 2026
• Last Verified: September 1, 2026

More Information

Terms related to this study

• Keywords: cardiac arrest; cardiopulmonary resuscitation; chest compression; hand position
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Diseases; Heart Arrest
• Other Study ID Numbers: CPR hand position

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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