title: A comparison of the area of chest compression by the superimposed-thumb and the alongside-thumb techniques for infant cardiopulmonary resuscitation.
abstract: OBJECTIVE
  We investigated whether the superimposed-thumb technique could reduce the chest compression area in infant cardiopulmonary resuscitation (CPR).
  
  
  METHODS
  Charts and multidirectional computed tomography images of infants presented to four hospitals from January 2007 to September 2010 were reviewed retrospectively. We measured at the point of maximal anterior-posterior heart diameter the width of the sternum meter (S(ap)), vertical heart length from S(ap), length and width of the superimposed-thumb technique and length and width of the alongside-thumb technique. We studied the structures located underneath thumbs superimposed and thumbs alongside at S(ap) and S(nipple) (the sternum of the inter-nipple line).
  
  
  RESULTS
  In the 84 infants enrolled, the width of the sternum at S(ap), and the vertical heart length from S(ap) were 0.85 ± 0.31 and 1.71 ± 0.47 cm, respectively. The length and width of the superimposed-thumb technique were 1.65 ± 0.13 and 2.73 ± 0.22 cm, respectively. The length and width of the alongside-thumb technique were 3.00 ± 0.48 and 3.77 ± 0.24 cm, respectively. The liver was situated underneath thumbs superimposed at S(ap) in 59.5% infants. The livers and lungs of 73.8% and 64.3% infants, respectively, were underneath thumbs alongside at S(nipple).
  
  
  CONCLUSIONS
  In this study, we confirmed that the superimposed-thumb technique may reduce chest compression area in infant CPR. The lungs or livers were located more often underneath thumbs alongside at S(nipple) than underneath thumbs superimposed at S(ap). However, further studies are needed to validate the efficiency and safety of this technique.
authors.affiliation: Department of Emergency Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, South Korea.
authors.forename: Seung Han
authors.initials: SH
authors.lastname: Lee
authors.forename: Yong Chul
authors.initials: YC
authors.lastname: Cho
authors.forename: Seung
authors.initials: S
authors.lastname: Ryu
authors.forename: Jin Woong
authors.initials: JW
authors.lastname: Lee
authors.forename: Seung Whan
authors.initials: SW
authors.lastname: Kim
authors.forename: In Sool
authors.initials: IS
authors.lastname: Yoo
authors.forename: Yeon Ho
authors.initials: YH
authors.lastname: You
authors.forename: Byung Kook
authors.initials: BK
authors.lastname: Lee
authors.forename: Jung Soo
authors.initials: JS
authors.lastname: Park
authors.forename: Seung Soo
authors.initials: SS
authors.lastname: Park
authors.forename: Won Jun
authors.initials: WJ
authors.lastname: Jung
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006336:Heart Massage / Q000379:methods* / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D008348:Manikins; D011859:Radiography; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013909:Thorax; D013933:Thumb; D016896:Treatment Outcome