The superiority of the two-thumb over the two-finger technique for single-rescuer infant cardiopulmonary resuscitation

Abstract

The TTT produced deeper CCD compared with that of the TFT-R23 because the finger strength of the TTT was significantly higher than that of the TFT-R23.

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.…”

Differences in the performance of resuscitation according to the resuscitation guideline terminology during infant cardiopulmonary resuscitation: “Approximately 4 cm” versus “at least one-third the anterior-posterior diameter of the chest”

“…The results of the present study showed that compared to "at least one-third the anteriorposterior diameter of the chest", the term "approximately 4 cm" could significantly limit the CCD. The CCD has been reported to be usually higher with TT when compared to TFT [12,[31][32][33][34]. However, in this study, ACD and the proportion of cases wherein the adequate depth was achieved were significantly different between the groups for both TT and TFT (Fig 2).…”

“…The ACD for TFT with the index and middle fingers of the right hand was 41.6 ± 1.1 mm and the ACD for TT was 43.1 ± 0.9 mm in a previous study [12]. We hypothesized that the ACD with a target CCD of "approximately 4 cm" would be lower than that with a target CCD of "at least one-third the anterior-posterior diameter of the chest" by as much as the standard deviation (1.1 mm for TFT and 0.9 mm for TT).…”

“…Using a face shield, mouth-to-mouth ventilation was administered. The researcher who was in charge of data collection instructed the participants to use the index and middle fingers of the dominant hand when they used TFT for chest compressions, because the index and middle fingers (of the dominant hand) in combination are the most effective, second only to the two-thumb technique [12,13]. Additionally, for all experiments, the position of the participants was standardized as follows: the right-handed participants were asked to sit on the right side of the manikin and the left-handed participants were asked to sit on the left side of the manikin in the kneeling position.…”

Why should the two-thumb technique be used for infant cardiopulmonary resuscitation?

“…The mean (SD) chest com-pression pressure of OHCC was reported to be 75.1 (12.02) mmHg (compared with the two-handed chest compression technique: 86.6 [13.68] mmHg) [5]. However, the mean (SD) chest compression power of 2f was reported to be 13.7 (5.1) kg with the right index-middle finger and 12.6 (4.6) kg with the left index-middle finger (compared with 2T: 23.8 [10.1] kg) [6]. The diversity of 1H might conceal the difference in CCD between 2T and 2f.…”