title: Comparison of a two-finger versus two-thumb method for chest compressions by healthcare providers in an infant mechanical model.
abstract: OBJECTIVE
  To compare the two-finger versus the two-thumb method of chest compression on an infant model.
  
  
  METHODS
  
  
  
  METHODS
  an unblinded, prospective, cross-over experimental study.
  
  
  METHODS
  the metropolitan area of a city with a population of greater than 260,000.
  
  
  METHODS
  pediatric medical personnel and emergency workers. Anyone unable to complete the study was excluded.
  
  
  METHODS
  participants performed chest compressions on an infant mannikin for 2 min. PARTICIPANTS were randomized to use the two-finger method or the two-thumb method for the first minute. The investigators recorded the skillguide readings of green (correct), green and orange (too deep), red (wrong placement), or no light (too shallow). Sixty or more correct compressions were judged to be adequate.
  
  
  RESULTS
  Two hundred and nine participants completed the study. PARTICIPANTS included: 66 nurses, 45 EMTs, 38 physicians, 27 paramedics, 14 nurse's assistants/emergency department technicians, 10 firefighters, five respiratory therapists, and four students. Seventy-one percent (149/209) of participants failed to give adequate compressions by either method. Only 40 participants performed adequate compressions using the two-thumb method (95% confidence interval. 14-25%). Thirty-eight participants gave adequate compressions using the two-finger method (95% confidence interval, 13-24%). No statistically significant difference existed between the two groups (P = 0.877; the McNemar test). A statistically significant difference was found in the number of shallow compressions for each method. Forty participants (19.1%) had more than 40 compressions that were too shallow versus 15 (7.2%) using the two-thumb method (P < 0.005).
  
  
  CONCLUSIONS
  Medical personnel often fail to give adequate compressions. The two-thumb method was as adequate as the two-finger method. Overall, more compressions were measured as shallow with the two-finger method.
authors.affiliation: Department of Pediatrics, University of Louisville, KY 40202, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Whitelaw
authors.forename: B
authors.initials: B
authors.lastname: Slywka
authors.forename: L J
authors.initials: LJ
authors.lastname: Goldsmith
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000706:statistics & numerical data; D016001:Confidence Intervals; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods* / Q000706:statistics & numerical data; D008348:Manikins