title: Optimal chest compression technique for paediatric cardiac arrest victims.
abstract: BACKGROUND
  The aim of this study was to assess the quality of chest compressions performed by inexperienced rescuers using three different techniques: two-hand, right one-hand, and left one-hand.
  
  
  METHODS
  We performed a prospective, randomised, crossover study in a simulated 6-year-old paediatric manikin model. Each participant performed 2-minute continuous chest compressions, using three different techniques. Chest compression quality data, including compression rate, compression depth, and residual leaning was recorded by a Q-CPR™ compression sensor connected to HeartStart MRx (Philips Healthcare, Andover, MA, USA). To examine trends in chest compression performance over time, each 2-minute period was divided into six consecutive 20-second epochs.
  
  
  RESULTS
  The 36 participants completed 108 two-minute trials, consisting of a total of 25,030 compressions. The mean compression rates [95% confidence interval] were as follows: two-hand, 116.8 [111.7-121.9]; left one-hand, 115.0 [109.9-120.1]; and right one-hand, 115.5 [110.4-120.6] (p = 0.565). The mean compression depth for two-hand was 38.7 mm (37.1-40.2), which was higher than for left one-hand (36.3 mm [34.8-37.9]) or right one-hand (35.4 mm [33.9-37.0]) (p < 0.001). Chest compression depth declined over time, regardless of the technique (p < 0.001). The pattern of compression depth change over time was similar for all techniques (p > 0.999). The residual leaning rate was higher with two-hand (40.7 [27.9-53.5]) than that for left one-hand (29.2 [16.4-42.0]) or right one-hand (25.8 [13.0-38.6]) (p = 0.021).
  
  
  CONCLUSIONS
  For paediatric cardiopulmonary resuscitation by inexperienced rescuers, the two-hand technique has the advantage of producing deeper compressions than the one-hand technique, but it is accompanied by more frequent residual leaning. For the one-hand techniques, the right and left hand produced chest compressions of similar quality.
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. boringzzz@yuhs.ac.
authors.forename: Min Joung
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea. HSLEE1@yuhs.ac.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. DRSHKIM@yuhs.ac.
authors.forename: Seunghwan
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. pys0905@yuhs.ac.
authors.forename: Yoo Seok
authors.initials: YS
authors.lastname: Park
mesh_terms: D002648:Child; D018592:Cross-Over Studies; D004504:Education, Medical, Undergraduate; D005260:Female; D006336:Heart Massage / Q000592:standards*; D006801:Humans; D008297:Male; D008348:Manikins; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies