Improvement of chest compressions using a BariBoard (Iron Duck, Chicopee, USA) on a modified manikin simulating a morbidly obese patient (BMI=40 kg/m²).

Medical professionals from the critical care department.

201 participants.

DIY modifications of manikin by putting vacuum sealed bags of porcine fat were inserted into anterior and posterior pockets of a customised neoprene suit, which was placed on a resuscitation model to emulate a BMI of 40 kg/m².

Significantly higher overall efficacy of compressions in obese manikin and for adequate compression depth and recoil.

No statistically significant difference between the proportions of participants achieving an adequate compression rate.

After adjustment for confounders and interactions, there was no difference in overall efficacy between both groups.

Influence of manikin sex on chest compression rate, depth, recoil and hand-off time.

Layperson without a medical background performed chest compression-only CPR for 8 min.

198 participants were randomised 1:1 either to male or female manikin first.

No further information about adaptations given.

Significantly higher average compression rate in females vs male manikins (104 (±19) bpm vs 97 (±28) bpm, p=0.001).

Significantly lower number of insufficient recoil in female vs male manikins (13% (±22%) vs 24% (±29%), p<0.001).

No statistically significant differences in the remaining CPR metrics.

Influence of manikin sex on removing clothes and placement of rescuer hands of layperson.

Undergraduate students

Participants randomly assigned to do CPR with an AED on female or male manikin.

69 participants: 36 trained with standard and 33 with female manikin.

DIY modifications of manikin using silicone breasts, a wig, make-up, a front-opening brassiere and colour-coordinated women’s clothing.

Significantly more participants on the male manikin removed clothes completely (92% vs 42%).

Female participants assigned to female manikin removed significantly more often all clothes than male participants (67% vs 13%). No difference in removing clothes between men and women in male manikin.

Hand placement on male manikin showed more variability over a greater area of the chest, while hand placement on female manikin tended to be centred between the breasts.

Adequacy of thoracic compressions on a modified manikin simulating a morbidly obese patient (BMI=40 kg/m²). compared with a ‘standard’ non-obese manikin and participant-perceived measures of effectiveness, fatigue and pain

Medical professionals from the critical care department at Alice Springs Hospital, Australia.

101 participants

DIY modifications of ‘standard’ manikin by putting vacuum sealed bags of porcine fat were inserted into anterior and posterior pockets of a customised neoprene suit, which was placed on a resuscitation model to emulate a BMI of 40 kg/m².

Significantly lower adequacy for chest compression on obese manikin, and for each component of primary outcome as well.

No significant difference in the mean chest compression rate, but highly significant difference in both the mean compression depth achieved overall and, in each quartile, and the mean release velocity.

There was a significant difference in perceived effectiveness, fatigue and pain favouring the non-obese manikin.

Evaluate chest compression for three adult simulation manikins (‘standard’, obese, and morbidly obese)

Contribution of participant characteristics of height, weight, sex and upper body strength to the quality of chest compressions in obese and morbidly obese manikins.

Medical professionals from a for-profit cardiovascular specialty hospital.

61 participants

The thorax framework and the sensors from a standard CPR manikin were in the correct anatomical position in the adapted manikins.

Manikins to mimic an obese and a morbidly obese adult were created, manufactured, and tested by a professional in the field of manikin design and manufacturing by adding the calculated amount of a foam substance of a consistency similar to adipose tissue.

Significantly more successful chest compressions on ‘standard’ manikin, compared with both obese and morbidly obese manikins.

No significant difference in performance between the two obese manikins.

BMI of rescuer, upper body strength, ethnicity and manikin order were all significantly associated with the number of successful compressions.

To evaluate the influence of the use of a female manikin during CPR training on reported comfort levels pre- and post-training of trainees in performing CPR on women with a questionnaire.

Layperson as part of an annual training

79 participants: 58 using standard manikin and 21 female manikin

Pre-training and post-training survey

DIY modifications of ‘standard’ manikin with breast adjunct constructed from a lifecast silicone mould.

In the post-training survey comparison, trainees in the adjunct group reported greater comfort in performing CPR on women, compared with the control group.

This effect persisted for questions relating to both clothed and unclothed women.

Effect of manikin sex on the quality of chest compressions.

Students studying medical care and welfare without prior training.

34 participants (15 males, 19 females)

DIY modifications of ‘standard’ manikin by using silicone breasts and dressed in a brassiere, long skirt, long-sleeved shirt, and long-haired wig.

Significantly higher appropriate compression depth ratio (46.5 vs 73.6%) and significantly lower appropriate recoil ratio (92.2 vs 85.3%) of chest compressions on female manikins.

No significant difference in other outcomes.

Ability to perform chest compressions on an obese manikin.

Analyse the effect of American football protective equipment on the performance of chest compressions by emergency responders

Emergency responders performing 2 min of chest compressions on a ‘standard’ and an obese manikin, once with and once without chest/shoulder pads on.

50 participants

Obese patient was simulated using a Nasco Bariatric CPR Manikin (Nasco Healthcare Inc. Life/form, Saugerties, USA) (commercially available).

Mean compression depth significantly lower when performed on the obese manikin compared with ‘standard’ manikin, while chest recoil was significantly better in obese manikin.

No significant difference in chest compression rate.

Evaluate laypersons response to an unannounced simulated virtual reality cardiac arrest based on the victim’s sex.

Untrained laypersons using a virtual reality cardiac arrest system to simulate victim’s sex (female or male), while performing CPR on the ‘standard’ manikin.

75 participants

DIY immersive virtual reality system to simulate the sex of virtual manikin.

Non-significant difference between CPR performed on male vs female victims (65% vs 54%).

Non-significant difference between AED use for male vs female victims (21% vs 15%).

Effect of patient sex to time-to-first shock by untrained bystanders using a public access defibrillator.

Untrained laypersons

78 participants

Half of the participants trained with a ‘female’ manikin clothed in a front-opening hooded sweater with a bra underneath and another half with standard manikin.

DIY modifications of ‘standard’ manikin with a bra under sweater.

All participants successfully delivered a shock.

No statistically significant difference between the times to first shock of the female and male clothed manikin groups.

88.5% of the participants were able to correctly place the electrodes.

Observe the choice of manikin between the ‘standard’ manikin or black OBI manikin within ethnic groups and receive feedback on their choice.

Record opinions regarding the need for ethnically diverse manikins for BLS training.

Healthcare professionals

30 participants

Brayden OBI manikin (Innosonian Europe, Farnborough, UK) (commercially available) representing an ethnically appropriate adult black male with anatomically correct features.

From white or black backgrounds 56% chose black manikin, 60% from Asian group chose this manikin, and only 25% of participants from the mixed group (white Asian or Other) chose the diverse manikin.

56% of black participants stated that they identified more with black manikin, 33% said neither and 11% said ‘standard’ manikin.

78% of black participants thought it important that manikins reflect ethnicity. The same number felt that having black manikins will help improve CPR.

Most participants identifying as ‘black,’ strongly agreed that ethnically accurate manikins will help to improve CPR training.