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Introduction
The guidelines for basic life support (BLS) published by the European Resuscitation Council 1 and the International Liaison Committee on Resuscitation 2 describe one-rescuer cardiopulmonary resuscitation (CPR) for a lay rescuer without the use of equipment, and two-rescuer CPR for two healthcare professionals with the use of equipment such as a bag-valve-mask device. The use of a bag-valve-mask device has three major advantages: the possibility of administering supplementary oxygen (up to 100% for bag-valve-mask devices with demand valve), avoidance of transmission of infections (such as tuberculosis 3 or severe acute respiratory distress syndrome 4 ) and, presumably, a reduction in rescuer fatigue. The guidelines do not contain any statement with regard to a single rescuer using a bag-valve-mask device. There are three possibilities for performing CPR by a single rescuer using a bag-valve-mask device: Over-the-head CPR: performance of chest compressions and ventilations from over the head of the casualty according to the guidelines for CPR in confined spaces.
Lateral CPR: performance of chest compressions and ventilations from the side of the casualty according to the guidelines for one-rescuer CPR for a lay rescuer with mouth-to-mouth ventilation.
Alternating CPR: performance of chest compressions from the side of the casualty and ventilations from over the head of the casualty according to the guidelines for CPR for two healthcare professionals.
A few studies of one-rescuer over-the-head CPR have been reported. 5-11 The results of these studies are controversial, and they were performed according to the 2000 guidelines, 12 in which the compression-ventilation ratio was 15:2, compared to 30:2 according to the 2005 guidelines. Change of position (side to head) has never been studied.
The purpose of this study was to analyse, on a manikin, the efficacy of three CPR positions performed by a single rescuer using a bag-valve-mask device and to compare CPR quality of the single-rescuer positions with standard dual-operator CPR. Such a situation where a single rescuer equipped with a bag-valve-mask device is present and the victim is lying on the floor is possible in a prehospital scenario or at the hospital with a patient collapsed out of bed. Another scenario for over-the-head CPR technique is a cardiac arrest situation with two rescuers at a scene, with one rescuer beginning CPR alone while the other...