%0 Journal Article
%T Sex Representation in CPR Training Manikins and Its Impact on Resuscitation Performance: A Randomized Crossover Simulation Study
%A Liam O’Connor
%A Fiona Murphy
%A Sean Doyle
%A Emma Walsh
%A Patrick Byrne
%J Journal of Integrative Nursing and Palliative Care
%@ 3006-5550
%D 2026
%V 7
%N 1
%R 10.51847/xucGaemTqT
%P 87-94
%X Female patients face a significantly lower probability of receiving bystander or in-hospital cardiopulmonary resuscitation (CPR) than male patients, contributing to poorer post-arrest survival outcomes. Traditional resuscitation pedagogy relies heavily on training simulators that replicate lean, white, male anatomy. This project analyzes whether the physical sex characteristics of a training manikin affect clinical performance during simulated cardiac emergencies. We designed a randomized, prospective, crossover simulation experiment involving 52 internal medicine residents. Each subject managed two distinct ventricular fibrillation scenarios, featuring a male-bodied and a female-bodied simulator, in an alternating sequence (distributed via 1:1 allocation to either a female-first or a male-first track), separated by a 4 h intervention-free interval. The primary endpoint was the time from the onset of ventricular fibrillation to the administration of a shock. In contrast, secondary endpoints tracked the elapsed time to initial chest compressions, pad application, and rhythm diagnosis, as well as objective CPR quality metrics (depth, rate, and compression fraction). Linear mixed-effects statistical models were applied to analyze the data, adjusting for participant sex and clinical background. Trainees assigned to the female-first track demonstrated delayed time to defibrillation (28.05, P < 0.006), lengthened time to compressions (12.08 s, P = 0.007), prolonged pad application (14.58 s, P < 0.001), and slower identification of ventricular fibrillation (17.79 s, P = 0.004) when managing the female simulator compared to colleagues in the male-first track. Furthermore, the duration spent within the optimal compression depth range was lower for the female-first cohort (11.02%, P = 0.027). Resuscitation quality was compromised when providers encountered the female simulator at the beginning of testing, revealing an asymmetrical improvement curve, which indicates that presentation sequence alone cannot account for the performance gap. Incorporating female-presenting simulators early and routinely into medical education curricula could optimize cognitive readiness and help eliminate sex-based disparities during real-world resuscitations.
%U https://journalinpc.com/article/sex-representation-in-cpr-training-manikins-and-its-impact-on-resuscitation-performance-a-randomize-4ris8wjzcjgckml