Optimizing CPR performance: the role of body composition and ergonomic positioning

Background: Quality cardiopulmonary resuscitation (CPR) is associated with improved survival rates in prehospital arrest cases. Although CPR guidelines emphasize compression depth, rate, and recoil, individual anatomical and biomechanical factors influencing CPR performance remain underexplored. This study aims to determine the optimal CPR position by focusing on individual positional conditions and anthropometric data to improve CPR effectiveness and guide team member selection in emergency scenarios. Methods: A cross-sectional study involving 123 paramedic associate degree students was conducted. Anthropometric measurements including upper extremity length, biceps circumference, and femur length were obtained. CPR performance was assessed using a feedback-capable mannequin, with data collected on compression depth, frequency, rhythm quality, and compression/decompression ratios. Positional parameters such as knee and hip angles, distance between knees, and distance from the mannequin were recorded and analyzed in relation to CPR outcomes. Results: Male participants demonstrated significantly higher CPR quality scores than females (65.09 ± 28.26 vs. 48.85 ± 27.11, p = 0.004). Positive correlations were found between BMI (r = 0.239, p = 0.008), upper extremity length (r = 0.364, p < 0.001), biceps circumference (r = 0.350, p < 0.001), and CPR quality metrics. A moderate inter-knee position (shoulder-width distance) provided superior compression depth and rhythm stability compared to narrow or wide positions (p < 0.001). Conclusion: Anthropometric and positional factors significantly influence CPR performance. Emergency team members with appropriate physical profiles (e.g., greater muscle mass, limb length, BMI) and adopting occupational ergonomic factors (e.g., moderate knee range, limited joint flexion) may improve CPR quality in the prehospital setting.