Standing chest compressions: simulation-based development and evaluation of a clinically applicable height adjustment approach

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• Picked for Emergency Medicine (paper of the day, 24 September 2026): Standing chest compressions height optimization

Abstract

INTRODUCTION: When hospital staff perform cardiopulmonary resuscitation, patients are usually lying on a bed or stretcher, and chest compressions are therefore commonly performed while standing. Current resuscitation guidelines do not provide recommendations regarding standing chest compressions. The aim of this study was to identify a favourable working height for high-quality standing chest compressions. MATERIAL AND METHODS: This prospective study included ten healthcare professionals and twenty medical students and was conducted in two parts. Firstly, chest compressions were performed at seven different working heights, starting from knee height as a reference mark. Additional heights were set at 10, 15, and 20 cm above (+) and below (-) knee height. Secondly, knee height setting was then evaluated by comparing chest compression quality with two clinically relevant reference conditions: kneeling on the floor and standing at the lowest stretcher height. RESULTS: In Part 1, the highest values for the primary outcome measures - mean compression depth (52.7 ± 7.9 mm) and the percentage of correct compression depth (80.6 ± 38.5%) - were achieved at knee height. Working heights of 15 and 20 cm above knee height yielded significantly lower compression depth results than at knee height. In Part 2, no significant differences in chest compression depth were observed between the three evaluated positions. CONCLUSION: Setting the patient's bed or stretcher to the rescuers' knee height enables high-quality chest compressions to be delivered while standing. The working height should be adjusted accordingly, with great emphasis placed on avoiding heights that are too high. The findings suggest that the performance of chest compressions while standing may warrant greater attention in future resuscitation guidelines.

Abstract as published, via PubMed.