title: Effects of alternating hands during in-hospital one-handed chest compression: A randomised cross-over manikin trial.
abstract: OBJECTIVE
  We evaluated the decrease in chest compression depth during continuous one-handed chest compression (OHCC) in an in-hospital paediatric arrest setting, and whether switching hands could delay the decrease in chest compression depth.
  
  
  METHODS
  In total, 30 healthcare providers were randomised into groups A and B. Group A performed test 1 (chest compressors alternated hands every 30 s in 2 min of OHCC), followed by test 2 (chest compressors used one hand for 2 min without switching to the other hand) and group B, vice versa. Participants performed 2 min continuous OHCC on a paediatric manikin on a bed. Mean compression depth (MCD) and mean compression rate (MCR) were analysed at 30 s intervals.
  
  
  RESULTS
  The MCDs in 30 s intervals changed significantly with time passed in tests 1 and 2 (0-30 s: 43.4 ± 7.4 vs 42.8 ± 7.6 mm, 30-60 s: 42.8 ± 8.7 vs 40.3 ± 8.8 mm, 60-90 s: 40.5 ± 8.9 vs 38.2 ± 9.6 mm, 90-120 s: 40.2 ± 10.2 vs 36.9 ± 9.7 mm; P < 0.01). However, with the exception of the first 30 s interval, MCD in test 1 showed significantly higher values than in test 2 (P < 0.05). The MCRs in 30 s intervals did not change significantly with time passed in all tests and were not different between the two tests. All hand-off times measured during switching hands in test 1 were less than 1 s.
  
  
  CONCLUSIONS
  Chest compression depth decreased significantly when continuous OHCC was performed without switching hands. Alternating hands every 30 s can delay the decrease in MCD and maintain deeper MCD for longer.
authors.affiliation: Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Sin Ae
authors.initials: SA
authors.lastname: Cheong
authors.affiliation: Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Je Hyeok
authors.identifier: http://orcid.org/0000-0002-5211-3838
authors.initials: JH
authors.lastname: Oh
authors.affiliation: Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Chan Woong
authors.initials: CW
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Lee
keywords: cardiac arrest; cardiopulmonary resuscitation; child; fatigue