A Multicenter International Randomized Controlled Manikin Study on Different Protocols of Cardiopulmonary Resuscitation for Laypeople: The MANI-CPR Trial

Enrico Baldi, Enrico Contri, Roman Burkart, Paola Borrelli, Ottavia Eleonora Ferraro, Martina Paglino, Marinella Pugliesi, Chiara Barbati, Daniele Bertaia, Christian Tami, Daniel Lopez, Susi Boldarin, Sandrine Dénéréaz, Michael Terrapon, Andrea Cortegiani

Research output: Contribution to journalArticlepeer-review


Background Compression-only cardiopulmonary resuscitation (CPR) is a suggested technique for laypeople facing out-of-hospital cardiac arrest (OHCA). However, it is difficult performing high-quality CPR until emergency medical services arrival with this technique. We aimed to verify whether incorporating intentional interruptions of different frequency and duration increases laypeople's CPR quality during an 8-minute scenario compared with compression-only CPR. Methods We performed a multicenter randomized manikin study selecting participants from 2154 consecutive laypeople who followed a basic life support/automatic external defibrillation course. People who achieved high-quality CPR in 1-minute test on a computerized manikin were asked to participate. Five hundred seventy-six were enrolled, and 59 were later excluded for technical reasons or incorrect test recording. Participants were randomized in an 8-minute OHCA scenario using 3 CPR protocols (30 compressions and 2-second pause, 30c2s; 50 compressions and 5-second pause, 50c5s; 100 compressions and 10-second pause, 100c10s) or compression-only technique. The main outcome was the percentage of chest compressions with adequate depth. Results Five hundred seventeen participants were evaluated. There was a statistically significant difference regarding the percentage of compressions with correct depth among the groups (30c2s, 96%; 50c5s, 96%; 100c10s, 92%; compression only, 79%; P = 0.006). Post hoc comparison showed a significant difference for 30c2s (P = 0.023) and for 50c5s (P = 0.003) versus compression only. Regarding secondary outcome, there were a higher chest compression fraction in the compression-only group and a higher rate of pauses longer than 10 seconds in the 100c10s. Conclusions In a simulated OHCA, 30c2s and 50c5s protocols were characterized by a higher rate of chest compressions with correct depth than compression only. This could have practical consequences in laypeople CPR training and recommendations. Clinical Trial Registration: NCT02632500

Original languageEnglish
Pages (from-to)239-245
Number of pages7
JournalSimulation in Healthcare
Issue number4
Publication statusPublished - 2021


  • Compression-only CPR
  • high-quality CPR
  • laypeople
  • training

ASJC Scopus subject areas

  • Epidemiology
  • Medicine (miscellaneous)
  • Education
  • Modelling and Simulation


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