Rethinking CPR training: when the "man" in manikin affects performance, a randomized crossover simulation study.

Pooja A Nawathe, Falisha F Kanji, Efren Esteves, Yujie Cui, Russell D Metcalfe-Smith, Tara Cohen

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Article in Resuscitation plus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Pooja A NawatheDepartment of Pediatrics, Cardiology and Computational Biomedicine, Cedars-Sinai Health Sciences University, 8700 Beverly Blvd., North Tower, Suite 4221, Los Angeles, CA 90048, USA.

Falisha F KanjiCedars-Sinai Medical Center, Department of Surgery, 6500 Wilshire Blvd, STE 1500, Los Angeles, CA 90048, USA.

Efren EstevesCedars-Sinai Medical Center, Women's Guild Simulation Center, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA.

Yujie CuiCedars-Sinai Medical Center, Department of Cancer Institute Shared Services, 700 N San Vicente Blvd, Green Building G593, West Hollywood, CA 90069, USA.

Russell D Metcalfe-SmithSimulation, Interprofessional Education and Library Services, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., The Susanne and Ervin Bard Pavilion, A-1300, Los Angeles, CA 90048, USA.

Tara CohenSurgical Safety and Human Factors Research, Department of Surgery, Cedars-Sinai Medical Center, 8631 West 3rd Street, MOTW 430.8E, Los Angeles CA 90049, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Women are less likely to receive bystander or in-hospital cardiopulmonary resuscitation (CPR) than men and have lower survival rates following cardiac arrest. Current CPR training relies heavily on manikins that represent white, lean, male-presenting bodies. This study investigates whether manikin sex influences CPR performance using simulated cardiac arrest scenarios. Methods: We conducted a randomized crossover simulation trial of 52 internal medicine residents who completed two ventricular fibrillation arrest scenarios using male-bodied and female-bodied manikins in alternating order (1:1 allocation to female-first vs male-first) separated by a 4‑h washout period. The primary outcome was time from ventricular fibrillation onset to defibrillation and secondary outcomes included time to compressions, time to pad placement, time to recognition of ventricular fibrillation, and CPR quality metrics (depth, rate, and compression fraction). Data were analyzed using linear mixed-effects models controlling for participant sex and experience. Results: Participants in the female-first condition demonstrated delayed time to defibrillation (28.05, Conclusions: CPR performance was inferior when the female manikin was encountered first, with an asymmetric improvement pattern suggesting presentation order alone does not fully explain the gap. Early and routine female manikin representation in CPR education may improve cognitive readiness and attenuate sex-based disparities in resuscitation performance.

Indexed as

Cardiac arrestCardiopulmonary resuscitationImplicit biasResuscitation trainingSex disparitiesSimulation-based education

Identifiers

PMID42253490

DOI10.1016/j.resplu.2026.101364

PMCPMC13233777

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LicenceCC BY-NC-ND

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.