Ergonomic Considerations in Neonatal Cardiopulmonary Resuscitation

BACKGROUND: Prolonged neonatal cardiopulmonary resuscitation (CPR) is critical for survival in cases of severe bradycardia due to asphyxia. High-performance CPR, emphasizing consistent compression depth and full recoil, improves survival rates. PURPOSE: This pilot study explored how environmental and provider-specific factors-including bed height, positioning, and anthropometry-affect the consistency of neonatal CPR using the 2-thumb technique. METHODS: Twenty-two neonatal intensive care unit providers performed 2-minute CPR trials on a neonatal simulator under 2 conditions: self-selected bed height ("choice") and standardized bed height (100 cm, "pre-set"). Compression depth and recoil were recorded using simulator sensors. Postural changes and onset of sway were assessed via video analysis. Results from the head-of-bed position were compared with data from a prior side-of-bed study. RESULTS: Chest recoil decreased over time in both bed-height conditions, potentially compromising CPR effectiveness. Bed height did not impact the number of postural changes or time to sway with a head-of-bed approach. Compared to the side-of-bed position, head-of-bed placement resulted in fewer postural changes and delayed onset of sway. In the choice condition, taller providers and those with longer reach preferred higher bed heights. IMPLICATIONS FOR PRACTICE AND RESEARCH: The head-of-bed approach may enhance motor performance by allowing pelvic stabilization against the bed, limiting lower-joint motion, and improving stability. However, this position may impair chest recoil over time, potentially reducing CPR effectiveness. Further research is needed to optimize ergonomic factors influencing neonatal resuscitation performance.