title: Evaluation of new two-thumb chest compression technique for infant CPR performed by novice physicians. A randomized, crossover, manikin trial.
abstract: BACKGROUND
  The impact of high-quality chest compressions during CPR for the patients' outcome is undisputed, as it is essential for maintaining vital organ perfusion. The aim of our study is to compare the quality of chest compression (CC) and ventilation among the two current standard techniques with our novel "nTTT" technique in infant CPR.
  
  
  METHODS
  In this randomized crossover, manikin trial, participants performed CCs using three techniques in a randomized sequence: standard two finger technique (TFT); standard two thumb technique (TTHT), and the 'new two-thumb technique' (nTTT). The novel method of CCs in an infant consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist.
  
  
  RESULTS
  Median depth compression using the distinct chest compression techniques varied and amounted to 26 [IQR, 25-28] mm for TFT, and 39 [IQR, 39-39] mm for TTHT as well as for nTTT. Best percentage of fully released compressions were received using TFT (100[100-100] %), then in the case of nTTT (99[98-100] %), and the worst in situation where TTHT (18[14-19] %). was used. The fastest chest compression rate was achieved with TFT (134[IQR, 129-135]/min) and the slowest when using nTTT (109 [IQR, 105-111]/min).
  
  
  CONCLUSIONS
  We found that our new nTTT technique's performance, in terms of compression depth, hands-off time, and ventilation quality, is comparable to the current standards. Based on our findings of this initial manikin study, the nTTT technique is superior to TFT in many of parameters that are vital to a quality chest compression during pediatric CPR.
authors.affiliation: Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Smereka
authors.affiliation: Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland. Electronic address: lukasz.szarpak@gmail.com.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Szarpak
authors.affiliation: Department of Clinic of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Smereka
authors.affiliation: Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Leung
authors.affiliation: Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA.
authors.forename: Kurt
authors.initials: K
authors.lastname: Ruetzler
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D005385:Fingers; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000379:methods* / Q000592:standards; D006801:Humans; D007223:Infant; D008297:Male; D008348:Manikins; D010820:Physicians; D011312:Pressure; D013933:Thumb; D055815:Young Adult