Feedback devices have been shown to improve the quality of chest compression during cardiopulmonary resuscitation for patients in the supine position, but no studies have reported the effects of feedback devices on chest compression when the chest is tilted. Basic life support-trained providers were randomly assigned to administer chest compressions to a manikin in the supine, 30 degrees left lateral tilt and 30 degrees semirecumbent positions, with or without the aid of a feedback device incorporated into a smartphone. Thirty-six participants were studied. The feedback device did not affect the quality of chest compressions in the supine position, but improved aspects of performance in the tilted positions. In the lateral tilted position, the median (IQR [range]) chest compression rate was 99 (99-100 [96-117])compressions.min(-1) with and 115 (95-128 [77-164])compressions.min(-1) without feedback (p=0.05), and the proportion of compressions of correct depth was 55 (0-96 [0-100])% with and 1 (0-30 [0-100])% without feedback (p=0.03). In the semirecumbent position, the proportion of compressions of correct depth was 21 (0-87 [0-100])% with and 1 (0-26 [0-100])% without feedback (p=0.05). Female participants applied chest compressions at a more accurate rate using the feedback device in the lateral tilted position but were unable to increase the chest compression depth, whereas male participants were able to increase the force of chest compression using the feedback device in the lateral tilted and semirecumbent positions. We conclude that a feedback device improves the application of chest compressions during simulated cardiopulmonary resuscitation when the chest is tilted
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