Successful out-of-hospital cardiac arrest (OHCA) management depends on prompt, effective interventions, particularly high-quality chest compressions and early defibrillation. While the European Resuscitation Council (ERC) currently advises sternal-apical pad placement, alternative configurations such as anterior-posterior (AP) are increasingly considered. The practical challenges of combining AP pad placement with mechanical cardiopulmonary resuscitation (mCPR) remain largely uninvestigated. This randomized simulation study examined the effect of AP pad placement on interruptions to chest compressions among 45 Dutch ambulance teams. Participants were divided into three groups: (1) manual compressions with AP pad application, (2) sequential mCPR followed by AP pad placement, and (3) simultaneous mCPR and AP pad application. The main outcome was total duration of chest compression interruptions, while secondary outcomes included ease of use and placement accuracy. Manual AP pad placement required an average of 38.3 ± 13.3 seconds, causing 12.1 ± 6.0 seconds of pauses. Sequential mCPR with AP pad application took 97.7 ± 23.7 seconds, resulting in 51.7 ± 14.0 seconds of compression interruptions. Simultaneous application lasted 70.5 ± 16.1 seconds, with 31.8 ± 12.3 seconds of interruptions. Correct pad placement was rare: 0% sternal, 11% apical, 13% anterior, and 2% posterior. Participants’ confidence in their technique did not correspond to accuracy. AP pad placement during ongoing mCPR is challenging and significantly prolongs interruptions in chest compressions. Ambulance crews should carefully evaluate the need for AP pads before initiating mCPR. The study highlights marked variability in pad positioning, emphasizing the necessity for standardized training and clear procedural guidance.
