The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial.
BACKGROUND
The aetiology of sudden cardiac arrest in infants is different from that in adults, with respiratory failure, sudden infant death syndrome, and drowning being the primary causes in the former. According to the European Resuscitation Council (ERC) and American Heart Association (AHA) recommendations, the quality of chest compressions (CC) is a key element affecting the effectiveness of cardiopulmonary resuscitation (CPR). The current ERC and AHA guidelines recommend the 'two-finger technique' (TFT) or 'two-thumb encircling hands technique' (TTHT) for external CCs during infant CPR.


OBJECTIVE
The aim of the randomised crossover manikin trial was to assess the CC quality during simulated resuscitation in infants performed by paramedics.


METHODS
A prospective, randomised, crossover, single-centre study was conducted between June and August 2016. The study material consisted of 120 fully trained and licensed paramedics (39 females, 32.5%) with a minimum of five years of professional experience (mean 7.5 ± 4.8 years) in emergency medicine (mean age, 30.5 ± 5.5 years). The participants performed CCs using three techniques: TFT (the rescuer compresses the sternum with the tips of two fingers); TTHT; and the 'new two-thumb technique' (nTTT). The novel method of CCs in an infant consists of using two thumbs directed at the angle of 90 degrees to the chest while closing the fingers of both hands in a fist.


RESULTS
The median CC rate when using the TFT, the TTHT, and nTTT methods varied and amounted to 134 min-1 vs. 126 min-1 vs. 114 min-1, respectively. There was a statistically significant difference in the median CC frequency between TFT and TTHT (p < 0.001), TFT and nTTT (p < 0.001), and between TTHT and nTTT (p < 0.001). The highest percentage of compressions with the frequency recommended by the ERC guidelines (100-120 min-1) was achieved by the study participants only with the nTTT. The median CC depth during the TFT was 28 mm (interquartile range [IQR] 27-30 mm) and was significantly lower than in the static TTHT (40.5 [IQR 39-41] mm; p < 0.001) and nTTT (40 [IQR 39-41] mm; p < 0.001). The percentage of adequate depth CCs was correctly obtained with TTHT and nTTT. The largest proportion of total decompression of the chest was observed with the nTTT technique (96 [IQR 96-98] %), followed by TFT (95.5 [IQR 85.5-99] %) and TTHT (5 [IQR 3-7] %). In all scenarios, the correct placement of the CC point was achieved in more than 90% of cases.


CONCLUSIONS
Our novel infant CC method provides the highest percentage of CCs with the frequency recommended by the ERC guidelines as compared with standard techniques. It also allows optimal CC depth.
Jacek
J
Smereka
Mariusz
M
Kasiński
Adam
A
Smereka
Jerzy R
JR
Ładny
Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland, Poland. lukasz.szarpak@gmail.com.
Łukasz
Ł
Szarpak
D000328:Adult; D000488:Allied Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards; D018592:Cross-Over Studies; D016757:Death, Sudden, Cardiac; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008348:Manikins; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011897:Random Allocation; D016896:Treatment Outcome
cardiopulmonary resuscitation; chest compression; infant; paramedic; quality