title: Effect of alternative chest compression techniques in infant and child on rescuer performance.
abstract: OBJECTIVE
  Current chest compression (CC) guidelines for an infant recommend a two-finger (TF) technique with lone rescuer and a two- thumb (TT) technique with two rescuers, and for a child either an one hand (OH) or a two hand (TH) technique with one or two rescuers. The effect of a 30:2 compression:ventilation ratio using these techniques on CC quality and rescuer fatigue is unknown. We hypothesized that during lone rescuer CC, TT technique, in infant and TH in child achieve better compression depth (CD) without additional rescuer fatigue compared with TF and OH, respectively.
  
  
  METHODS
  Randomized observational study.
  
  
  METHODS
  University-affiliated pediatric hospital.
  
  
  METHODS
  Adult healthcare providers certified in basic life support or pediatric advanced life support.
  
  
  METHODS
  Laerdal baby advanced life support trainer and Resusci junior manikin were modified to digitally record CD, compression pressure (CP) and compression rate. Sixteen subjects were randomized to each of the four techniques to perform 5 minutes of lone rescuer 30:2 compression:ventilation cardiopulmonary resuscitation. Rescuer heart rate (HR) and respiratory rate were recorded continuously and the recovery time interval for HR/respiratory rate to return to baseline was determined. Subjects were blinded to data recording. Groups were compared using two-sample, two-sided Student's t tests.
  
  
  RESULTS
  Two-thumb technique generated significantly higher CD and peak CP compared with TF (p < 0.001); there was no significant difference between OH vs. TH. TF showed decay of CD and CP over time compared with TT. Compression rate (per minute) and actual compressions delivered were not significantly different between groups. No significant differences in fatigue and recovery time were observed, except the TT group had greater increase in the rescuer's HR (bpm) from baseline compared with TF group (p = 0.04).
  
  
  CONCLUSIONS
  Two-thumb compression provides higher CD and CP compared with TF without any evidence of decay in quality and additional rescuer fatigue over 5 minutes. There was no significant difference in child CC quality or rescuer fatigue between OH and TH. Two-thumb technique is preferred for infant CC and our data support the current guidelines for child CC.
authors.affiliation: University of Florida, Gainesville, FL, USA.
authors.forename: Jai P
authors.initials: JP
authors.lastname: Udassi
authors.forename: Sharda
authors.initials: S
authors.lastname: Udassi
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Theriaque
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Shuster
authors.forename: Arno L
authors.initials: AL
authors.lastname: Zaritsky
authors.forename: Ikram U
authors.initials: IU
authors.lastname: Haque
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002675:Child, Preschool; D004502:Education, Medical, Continuing; D005221:Fatigue; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011312:Pressure; D016037:Single-Blind Method