title: Over-the-head two-thumb encircling technique as an alternative to the two-finger technique in the in-hospital infant cardiac arrest setting: a randomised crossover simulation study.
abstract: OBJECTIVE
  To determine if the over-the-head two-thumb encircling technique (OTTT) provides better quality cardiopulmonary resuscitation (CPR) than the conventional two-finger technique (TFT) when performed by a lone rescuer in an in-hospital infant cardiac arrest setting.
  
  
  METHODS
  This prospective, randomised crossover design study recruited 50 nurses who voluntarily performed lone rescuer infant CPR for 2 min on a manikin. Participants who performed OTTT stood at the head of the manikin to compress the chest and provide bag-valve mask ventilations, whereas those who performed TFT stood by the side of the manikin to compress the chest and provide pocket-mask ventilations. Mean hands-off time, mean compression depths and rates, proportion of effective compressions and complete recoil, and fatigue score changes were assessed during the test, and a survey on the ease of use of the techniques was conducted after the test.
  
  
  RESULTS
  Hands-off time, total ventilation volume and number of ventilations were not significantly different between the two techniques. OTTT resulted in greater depth of compressions (p<0.001), greater proportion of effective compressions (p<0.001), smaller proportion of complete recoil (p=0.001), and smaller fatigue score change (p=0.003) than TFT. In addition, subjects reported that compression, ventilation and changing compression to ventilation were easier using OTTT than TFT.
  
  
  CONCLUSIONS
  OTTT performed by a lone rescuer in an in-hospital infant cardiac arrest setting resulted in greater compression depth, with no increase in hands-off time, compared with TFT. OTTT may therefore be a suitable alternative to TFT in the in-hospital infant cardiac arrest setting.
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Republic of Korea.
authors.forename: Choong Hyun
authors.initials: CH
authors.lastname: Jo
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Republic of Korea.
authors.forename: Hwan Suk
authors.initials: HS
authors.lastname: Jung
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Republic of Korea.
authors.forename: Gyu Chong
authors.initials: GC
authors.lastname: Cho
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Republic of Korea.
authors.forename: You Jang
authors.initials: YJ
authors.lastname: Oh
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D018592:Cross-Over Studies; D005221:Fatigue; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008348:Manikins; D011446:Prospective Studies; D055815:Young Adult
keywords: cardiac arrest; research, methods; resuscitation