Human factors and ergonomics strategies in cardiopulmonary resuscitation: A systematic review of rescuer fatigue and CPR quality outcomes
DOI: https://doi.org/10.33024/min.v9i8.4353
Cardiopulmonary Resuscitation Ergonomics Fatigue Human Factors Nurses Simulation Training
Abstract
Background: High-quality cardiopulmonary resuscitation (CPR) is physically and cognitively demanding, while rescuer fatigue can reduce chest-compression performance. Human Factors and Ergonomics (HFE) provides a systems-based approach integrating posture, workload, teamwork, technology, and the clinical environment.
Purpose: To synthesize primary evidence regarding the effects of HFE-informed CPR education and performance strategies on rescuer fatigue and CPR quality.
Method: This systematic review followed the PRISMA 2020 guidelines. PubMed, ScienceDirect, SpringerLink, and Google Scholar were searched for peer-reviewed primary studies published between January 2020 and December 2025. Eligible studies examined at least one HFE component and reported fatigue, CPR-quality, or team-performance outcomes. Twenty primary studies were included, critically appraised using design-appropriate Joanna Briggs Institute tools, and narratively synthesized because of methodological heterogeneity.
Results: Real-time feedback, ergonomically appropriate positioning, workload management, planned compressor rotation, effective leadership, and team-based simulation generally improved compression depth, compression rate, chest-compression fraction, and team coordination. Conversely, prolonged chest compressions, suboptimal posture, forward leaning, personal protective equipment, and demanding patient positions increased rescuer fatigue. Nevertheless, evidence directly evaluating a comprehensive HFE-based CPR training program specifically for nurses remained limited.
Conclusion: HFE-informed strategies can improve immediate CPR performance, strengthen team coordination, and support fatigue management. However, a standardized nurse-focused HFE training program should be evaluated through robust multicenter clinical studies assessing fatigue, CPR quality, skill retention, musculoskeletal effects, and patient-centered outcomes.
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