Relationship Between Body Mass Index and Chest Compression Quality Following Standardized Basic Life Support Training in Nurses: A Prospective Simulation Study

Background: High-quality chest compressions are considered a fundamental component of effective cardiopulmonary resuscitation (CPR). Although body mass index (BMI) has been suggested to be associated with chest compression performance, the available evidence remains unclear, particularly among healthcare professionals evaluated under standardized training conditions. This study aimed to investigate the association between BMI and chest compression quality following standardized Basic Life Support (BLS) training in nurses. Methods: This prospective simulation study included 284 nurses who completed a standardized 45 min BLS training program. Chest compression performance was assessed individually using an AmbuMan® Basic CPR manikin during two minutes of uninterrupted chest compressions. Adequate compression rate, adequate compression depth, and complete chest recoil were evaluated according to the manufacturer’s performance criteria based on current ERC and AHA guidelines. Participants were classified into three BMI groups: <18.5, 18.5–24.9, and ≥25 kg/m2. Multivariable logistic regression was performed to evaluate the independent association between BMI and each chest compression quality parameter, adjusting for age, sex, nursing experience, previous BLS training, and working in an intensive care unit. Results: Participants with a BMI < 18.5 kg/m2 had significantly lower rates of adequate compression rate (15.0%) and adequate compression depth (45.0%) than those in the other two BMI groups (both p < 0.001). Complete chest recoil also differed significantly among BMI groups (p = 0.004). After adjustment for age, sex, nursing experience, previous BLS training, and working in an intensive care unit, BMI remained independently associated with adequate compression rate (adjusted OR 1.32, 95% CI 1.18–1.49; p < 0.001) and adequate compression depth (adjusted OR 1.29, 95% CI 1.14–1.47; p < 0.001), but not with complete chest recoil (adjusted OR 1.12, 95% CI 0.99–1.26; p = 0.072). Conclusions: Following standardized BLS training, nurses with a BMI < 18.5 kg/m2 showed lower rates of adequate compression rate and depth than those with higher BMI values, while BMI was not independently associated with complete chest recoil. These findings suggest an association between lower BMI and poorer performance in selected chest compression parameters within this simulation setting.