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.

Christoph Veigl is member of the Young European Resuscitation Council (ERC) committee. Simon Orlob is Secretary of the Austrian Resuscitation Council (ARC). Natalie Anderson was International Liaison Committee on Resuscitation (ILCOR) Education, Implementation and Teams (EIT) Task Force member. Sabine Nabecker is ILCOR EIT Task Force member, and ERC Instructor-Educator-Support Science and Education Committee member. Joachim Schlieber is Chair of the ARC. Federico Semeraro is President-Elect of the ERC. Robert Greif is Chair of the ILCOR EIT Task Force and ERC Director of Guidelines and ILCOR. Sebastian Schnaubelt is ILCOR EIT Task Force member, ERC Advanced Life Support Science and Education Committee member, and Vice-Chair of the Austrian Resuscitation Council.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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