Biomechanics of two-thumb versus two-finger chest compression for cardiopulmonary resuscitation in an infant manikin model

Abstract

Objective The loading force applied in infant external chest compression (ECC) has not been determined. The objective of this crossover study was to quantify the actual force involved in two-thumb (TT)-encircling hands and two-finger (TF) methods during infant cardiopulmonary resuscitation. Methods A total of 42 emergency medical professionals performed lone rescuer infant external chest compression (ECC) with TF and TT methods. The order of two methods was arranged randomly, with an interval of 30 min in between. The force was collected by MatScan as primary outcomes. The secondary outcomes, quality of chest compressions, and fatigue level were also recorded by SkillReporter and perceived exertion scale. Results Using the TT method, the rescuers performed cardiopulmonary resuscitation (CPR) with higher ECC quality, but more incomplete recoil than they did using the TF method. The mean compression forces delivered in the first and second minutes were 3.53 ± 1.27 kg and 3.22 ± 1.11 kg (P = 0.012) for TF and 4.11 ± 1.80 kg and 4.04 ± 1.83 kg (P = 0.568) for TT, respectively. Pairwise comparison indicates that the compression force delivered through the TF method during the first and second minute of ECC were inferior to that delivered through the TT method. The TF method involved greater perceived exertion than the TT method (5.27 ± 4.69 vs. 4.02 ± 2.31; P = 0.007). The median perceived exertions for the TF and TT methods were 5 and 4, respectively. Conclusion For infant CPR, the TT method involved greater loading force, lower fatigue, and higher overall ECC quality than the TF method. The optimal compression force is about 3.8–4.3 kg.

Part 4: Pediatric Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

“…Systematic reviews suggest that the 2-thumbencircling hands technique may improve CPR quality when compared with 2-finger compressions, particularly for depth. 42,43 However, recent manikin studies suggest that the 2-thumb-encircling hands technique may be associated with lower chest compression fractions (percent of cardiac arrest time that chest compression are provided) 44 and incomplete chest recoil, 45,46 especially when performed by single rescuers. See Figure 3 for the 2-thumb-encircling hands technique.…”

Analysis of Chest-Compression Depth and Full Recoil in Two Infant Chest-Compression Techniques Performed by a Single Rescuer: Systematic Review and Meta-Analysis

“…Finally, the TF technique has high compression pressure only at the fingertips, which may easily be misplaced with fatigued rescuers. In the Tsou et al study [25], the mean compression force of the TT technique was significantly higher than that of the TF technique, and the decrease of compression-force delivery during CPR was also significant in the TF technique. With respect to ergonomics, the TT technique is much superior to the TF technique.…”

“…However, we additionally evaluated complete chest recoil that is a crucial component known to contribute to HQ-CPR [39]. Second, one more eligible study was identified and included in the present study [25]. Third, we adopted a GOSH plot and unsupervised-learning algorithms to aid in exploring potential outliers contributing to the substantial heterogeneity observed in our results.…”

Two-Thumb or Two-Finger Technique in Infant Cardiopulmonary Resuscitation by a Single Rescuer? A Meta-Analysis with GOSH Analysis

“…Ten studies were crossover RCTs [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ], whereas three were parallel RCTs [ 28 , 29 , 30 ]. In Haque et al’s study [ 30 ], a total of 80 participants were randomly allocated to five groups, namely the infant TF, infant TT, child one-hand, child two-hand, and adolescent two-hand groups, with 16 participants in each group.…”

“…First, leave-one-out analysis revealed that all the pooled estimates after omitting one study at a time still lie within the 95% confidence interval of the overall estimate ( Figure 16 A). Second, the Baujat plot showed two studies located at the right side of the plot [ 18 , 21 ] ( Figure 16 B). The corresponding subsets including these potential outliers were shown in Figure 16 D. However, the GOSH plot remained heterogeneous after excluding the potential outliers ( Figure 16 C).…”