Usefulness of chest compression landmarks for improving the quality of infant cardiopulmonary resuscitation: a simulation study

BACKGROUND: This study aimed to determine whether using a visible landmark could improve the quality of infant cardiopulmonary resuscitation (CPR). METHODS: In this matched, randomized, simulation-based study conducted at a tertiary academic hospital, PALS-certified nurses who provided informed consent performed three cycles of infant chest compressions on a Laerdal Little Baby manikin equipped with a QCPR sensor. Each participant completed compressions under one of three randomized conditions: correct landmark, incorrect landmark, and no landmark. The primary outcome was compression accuracy, and the secondary outcome was hand position consistency across cycles. RESULTS: Twenty-seven PALS-certified nurses were enrolled and evenly randomized into the three groups. Mean compression accuracy was significantly higher in the correct-landmark group compared with the incorrect- and no-landmark groups (99.6% vs. 46.9% and 68.1%, respectively; p < 0.001). Compression depth and rate did not differ among groups, with all within the PALS-recommended range. Cycle-to-cycle spatial variability across cycles was also greatest in the correct-landmark group, demonstrating enhanced precision and reproducibility of infant chest compressions. CONCLUSION: In this simulation-based study, placing a visible landmark at the correct anatomical site significantly improved the accuracy and consistency of infant chest compressions. Further studies in clinical settings are warranted to validate these findings.