A Comparison between Three Different Techniques Considering Quality Skills, Fatigue and Hand Pain during a Prolonged Infant Resuscitation: A Cross-Over Study with Lifeguards

Abstract

The aim of the study was to compare the quality of CPR (Q-CPR), as well as the perceived fatigue and hand pain in a prolonged infant cardiopulmonary resuscitation (CPR) performed by lifeguards using three different techniques. A randomized crossover simulation study was used to compare three infant CPR techniques: the two-finger technique (TF); the two-thumb encircling technique (TTE) and the two-thumb-fist technique (TTF). 58 professional lifeguards performed three tests in pairs during a 20-min period of CPR. The rescuers performed compressions and ventilations in 15:2 cycles and changed their roles every 2 min. The variables of analysis were CPR quality components, rate of perceived exertion (RPE) and hand pain with numeric rating scale (NRS). All three techniques showed high Q-CPR results (TF: 86 ± 9%/TTE: 88 ± 9%/TTF: 86 ± 16%), and the TTE showed higher values than the TF (p = 0.03). In the RPE analysis, fatigue was not excessive with any of the three techniques (values 20 min between 3.2 for TF, 2.4 in TTE and 2.5 in TTF on a 10-point scale). TF reached a higher value in RPE than TTF in all the intervals analyzed (p < 0.05). In relation to NRS, TF showed significantly higher values than TTE and TTF (NRS minute 20 = TF 4.7 vs. TTE 2.5 & TTF 2.2; p < 0.001). In conclusion, all techniques have been shown to be effective in high-quality infant CPR in a prolonged resuscitation carried out by lifeguards. However, the two-finger technique is less efficient in relation to fatigue and hand pain compared with two-thumb technique (TF vs. TTF, p = 0.01).

Trained Lifeguards Performing Pediatric Cardiopulmonary Resuscitation While Running: A Pilot Simulation Study

“…The trained rescuers in our research obtained compression quality values of around 50%. Although recent research shows that professional lifeguards can perform compressions with over 80% quality on an infant manikin [ 15 ], Martin et al reported that even trained rescuers have difficulty performing adequate compressions during simulated infant CPR [ 19 ].…”

“…Quality parameters were evaluated and disaggregated in CC quality, V quality, and CPR quality. Each variable was expressed as a percentage; variable calculations were based on the following formulas published in previous studies [ 6 , 15 ]: CC quality, calculated using the formula: (CC with adequate depth + CC with correct chest recoil + CC with adequate rate) ÷ 3. V quality, calculated using the formula: Number of V with adequate volume ÷ Number of total V × 100.…”

“…The Rating of Perceived Exertion (RPE) was measured on a 0–10 scale [ 10 ]. RPE measurement using a modified Borg’s scale is common for estimating physical effort in CPR studies [ 6 , 15 , 16 , 17 ].…”

“…Quality parameters were evaluated and disaggregated in CC quality, V quality, and CPR quality. Each variable was expressed as a percentage; variable calculations were based on the following formulas published in previous studies [6,15]:…”

Is the Over-the-Head Technique an Alternative for Infant CPR Performed by a Single Rescuer? A Randomized Simulation Study with Lifeguards

“…In addition, a number of studies have been published that examine modified compression techniques in infants (<1 year old). However, these studies focus on finger placement in relation to the infant's chest with two rescuers rather than the rescuer's position in relation to the infant with a single rescuer [8][9][10][11]. Furthermore, other studies have compared the feasibility of OTH CPR with bag-mask ventilation versus pocket-mask ventilation in locations such as ambulances and hospitals [12,13].…”