Diversity of CPR manikins for basic life support education: Use of manikin sex, race, and body shape – A scoping review
Authors: Veigl Christoph , Schnaubelt Benedikt , Heider Sabine , Kornfehl Andrea , Orlob Simon , Baldi Enrico , Snijders Erwin , Anderson Natalie , Nabecker Sabine , Schlieber Joachim , Al-Hilali Zehra’ , Mustafa Mahmoud Tageldin , Krammel Mario , Semeraro Federico , Greif Robert , Schnaubelt Sebastian 
Published: February 2025

Cardiopulmonary resuscitation (CPR) manikins typically appear white, lean, and male. However, internationally, this does not represent the overall population or those who are at greatest risk of cardiac arrest. Diverse demographic groups including people of colour, women, and obese people, are known to be less likely to receive bystander CPR, public access defibrillation, and suffer less favourable outcomes. It is plausible that failure to represent women, racially diverse, and non-lean manikins can contribute to poor clinical outcomes in these populations. The aim of this scoping review was to summarize the current evidence for adaptations of manikins used for layperson Basic Life Support (BLS) training. Data on participant characteristics, manikin adaptations, study design, and key findings of included studies describing or evaluating CPR manikin diversity were extracted. Initially, 2,719 studies were identified and 15 studies were finally included and were grouped into 1) studies analyzing adaptions of “standard” manikins used in training (n=11) and 2) studies evaluating CPR manikin diversity used for online learning and on social media (n=4). Six of the studies analyzing different adaptations reported the influence of the manikins’ sex on comfort in performing CPR, quality of chest compression, AED use, and removing clothes, four the effects of obese manikins, and one an ethnically diverse manikin. Seven of the studies used do-it-yourself adaptions. Racial and gender diversity of CPR manikins found in educational videos was limited, with only 5% of educational videos featuring non-white manikins and 1% featuring female manikins. Adaptations of manikins used for BLS CPR training for laypersons still do not represent the diversity of communities most people are living in, internationally. There are hints that using diverse racial manikins has the potential to improve engagement in CPR training. Reported barriers hindering the use of adapted manikins were high costs and availability of these manikins.

What is already known on this topic

Manikins for layperson cardiopulmonary resuscitation (CPR) training are typically white, lean, and male all over the world.

Certain sociodemographic groups experience lower bystander rates, defibrillator use, and lower survival rates after out-of-hospital cardiac arrest.

What this study adds

The majority of manikins used in studies evaluating adaptions are do-it-yourself adaptions.

Only one study evaluated the view of ethnically diverse people on racial diverse manikins and how these adaptions should be conducted.

How this study might affect research, practice or policy

By raising awareness for these sociodemographic disparities in CPR training, educators all over the world should be part of the solution.

To improve cardiac arrest outcomes among these groups, organisations involved in CPR education should ensure diversity of manikins, and manufacturers should offer low-cost diverse manikins.