Left-Side Versus Right-Side Lateral Tilt During Maternal CPR: Effects on Compression Quality and Rescuer Fatigue

Background: Maternal cardiac arrest presents unique challenges due to physiological changes in pregnancy. Left lateral tilt (LLT) is commonly recommended to relieve aortocaval compression, but its impact on chest compression quality remains unclear. Objectives: This study evaluates chest compressions performed in the LLT position from both the right and left sides to determine if they meet high quality cardiopulmonary resuscitation standards. Methods: This randomized crossover study included 44 healthcare providers performing two-minute chest compressions’ sessions on a manikin in the LLT position from both right and left sides. Compression depth, rate, recoil, force distribution, rescuer fatigue, and physiological parameters were analyzed. Results: Both approaches maintained adequate compression rates, but left-side LLT chest compressions achieved better depth (41.23 ± 9.11 mm vs. 35.50 ± 9.54 mm, p < 0.001) and complete recoil (67.05 ± 39.05% vs. 38.39 ± 34.23%, p < 0.001). Left-side LLT chest compressions also generated higher peak force and lower residual release force. Right-side LLT chest compressions were associated with greater rescuer fatigue and instability. Conclusion: Left-side LLT chest compression provides superior compression depth and recoil compared with right-side LLT chest compression. However, neither method consistently meets high quality cardiopulmonary resuscitation standards. These findings support the 2015 AHA guideline preference for manual uterine displacement over LLT chest compression. Further research is needed to optimize maternal cardiac arrest management.