A vertical two-thumb technique is superior to the two-thumb encircling technique for infant cardiopulmonary resuscitation.
OBJECTIVE
The two-thumb encircling (TTE) technique often results in suboptimal cardiac compression and does not meet the requirements of current resuscitation guidelines. We compared this technique with the vertical two-thumb (VTT) technique, our novel modification of the TTE technique.


METHODS
This was a prospective randomised crossover simulation study of out-of-hospital infant cardiopulmonary resuscitation (CPR). Participants who had completed a basic life support course performed 10 cycles of cardiac compressions on a manikin for each technique.


RESULTS
We enrolled 36 medical doctors who had applied for a hospital internship in this study. The VTT generated significantly higher pressure than the TTE and the pressure difference ranged from 26.8 to 62.9 mmHg for each cycle, with a mean difference of 43.5 mmHg (95% CI, 37.8-49.2). The difference in pressure showed a tendency to increase with increasing cycles of cardiac compressions. The participants' heart and respiratory rate was higher with the VTT, but they said that it was easier to perform cardiac compressions with this technique.


CONCLUSIONS
The VTT technique generated more pressure than the TTE technique in a simulated model of infant out-of-hospital CPR. It can provide an alternative compression technique for effective infant CPR, especially for the rescuers with small hands or a weak grip.
Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Emergency Medicine, Graduate School, College of Medicine, Kangwon National University, Chuncheon, Korea.
Ji Ung
JU
Na
Pil Cho
PC
Choi
Hyun Jung
HJ
Lee
Dong Hyuk
DH
Shin
Sang Kuk
SK
Han
Jun Hwi
JH
Cho
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D018592:Cross-Over Studies; D005221:Fatigue; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008348:Manikins; D011312:Pressure; D011446:Prospective Studies; D013933:Thumb
Cardiac arrest; Cardiopulmonary resuscitation; Heart massage; Infant; Manikins