Effect of Rescuer Position on Chest Compression Quality and Rescuer Stability during CPR on a Sloped Surface: A Simulation Study

Introduction High-quality chest compressions (CCs) are essential for survival after cardiac arrest. Current cardiopulmonary resuscitation (CPR) guidelines recommend performing CCs on a firm and flat surface; however, cardiac arrest may also occur in austere environments such as mountainous or sloped terrain where such conditions cannot be achieved. This study aimed to evaluate the impact of rescuer positioning on CC quality during CPR on a slope. Methods A repeated-measures simulation study was conducted with 50 basic life support-trained volunteers. Participants performed uninterrupted CCs for 2 min in 3 different positions relative to the victim on a natural slope: uphill, downhill, and parallel. CC quality was assessed using a Resusci Anne QCPR manikin and the Laerdal QCPR application. Results Rescuer position significantly affected CC quality and subjective ratings ( P < 0.05). The downhill position achieved the highest proportion of time within the recommended compression rate range (median 90% vs 30% in the uphill position; P < 0.001) and deeper compressions (71 mm vs 67 mm; P < 0.001). In contrast, the uphill position was associated with higher compression rates and reduced chest recoil quality. Subjective assessments also differed significantly between positions. Compared with the downhill position, the uphill position was associated with greater physical demand, poorer stability, increased hand slipping, and greater fear of falling (all P < 0.001). Conclusions Rescuer position significantly influences CC quality and perceived rescuer safety during CCs on sloped terrain. Performing CCs from a downhill position may improve CC performance in austere and mountainous environments.