GIMS flags gaps in CPR hand placement guidelines, urges updates

Published in the inaugural issue of the Journal of Resuscitation, the review identifies critical gaps in the evidence supporting current CPR training guidelines, particularly for paediatric patients

A new study by the department of anaesthesiology at the Government Institute of Medical Sciences (GIMS), Greater Noida, has questioned the scientific basis of a fundamental step in cardiopulmonary resuscitation (CPR) — the exact placement of hands during chest compressions.

The study calls for global coordination to modernise CPR protocols, urging collaboration among emergency physicians, researchers, and resuscitation councils — particularly to boost under-represented paediatric clinical research.  (Sunil Ghosh/HT Archives)

Published in the inaugural issue of the Journal of Resuscitation, the review identifies critical gaps in the evidence supporting current CPR training guidelines, particularly for paediatric patients. Despite decades of global training campaigns, the researchers say the science behind hand positioning remains inconclusive and under-researched.

“Even after so many years of global CPR advocacy, we still lack conclusive data linking hand placement with survival or neurological outcomes,” said Dr Nazia Nazir, lead author of the study. “This review isn’t about overturning what we know; it’s about pointing out what we don’t know and encouraging smarter, evidence-based protocols.”

The study found that no hand position — whether at the midpoint of the sternum or near the xiphisternum — is definitively linked to better patient outcomes such as return of spontaneous circulation (ROSC), hospital discharge, or neurological recovery. The most commonly taught method of placing the heel of the hand on the lower half of the sternum remains more a convention than a scientifically proven best practice.

Based on existing data, the GIMS team recommends positioning both hands on the lower half of the sternum, about two fingerbreadths above the xiphisternum, with compressions initiated using the dominant hand’s heel, elbows locked and hands clasped.

“This isn’t about reinventing CPR,” said co-author Dr Savita Gupta. “It’s about refining it. We now need to move beyond general training models and ask sharper questions.”

The study calls for global coordination to modernise CPR protocols, urging collaboration among emergency physicians, researchers, and resuscitation councils — particularly to boost under-represented paediatric clinical research.

“In many ways, CPR training has stagnated,” Dr Nazir added. “We’ve built a global culture around compressions, but it’s time we apply the same rigour to how we teach them.”

GIMS director Dr Rakesh Gupta said, “The study reflects GIMS’ commitment to advancing evidence-based medicine. Even in areas as established as CPR, there is always room to question, refine, and improve.”