Comparison of two-thumb encircling and two-finger technique during infant cardiopulmonary resuscitation with single rescuer in simulation studies

Abstract

Background:The recommended chest compression technique for a single rescuer performing infant cardiopulmonary resuscitation is the two-finger technique. For 2 rescuers, a two-thumb-encircling hands technique is recommended. Several recent studies have reported that the two-thumb-encircling hands technique is more effective for high-quality chest compression than the two-finger technique for a single rescuer performing infant cardiopulmonary resuscitation. We undertook a systematic review and meta-analysis of infant manikin studies to compare two-thumb-encircling hands technique with two-finger technique for a single rescuer.Methods:We searched MEDLINE, EMBASE, and the Cochrane Library for eligible randomized controlled trials published prior to December 2017, including cross-over design studies. The primary outcome was the mean difference in chest compression depth (mm). The secondary outcome was the mean difference in chest compression rate (counts/min). A meta-analysis was performed using Review Manager (version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014).Results:Six studies that had reported data concerning both chest compression depth and chest compression rate were included. The two-thumb-encircling hands technique was associated with deeper chest compressions compared with two-finger technique for mean chest compression depth (mean difference, 5.50 mm; 95% confidence interval, 0.32–10.69 mm; P = .04), but no significant difference in the mean chest compression rate (mean difference, 7.89 counts/min; 95% confidence interval, to 0.99, 16.77 counts/min; P = .08) was noted.Conclusion:This study indicates that the two-thumb-encircling hands technique is a more appropriate technique for a single rescuer to perform high-quality chest compression in consideration of chest compression depth than the two-finger technique in infant manikin studies.

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.…”

Development of Smart-Ring-Based Chest Compression Depth Feedback Device for High Quality Chest Compressions: A Proof-of-Concept Study

“…Two CPR pilot tests on the mannequins, including the two-hand CC method for adults and the two-thumb CC method for infant, confirmed that the smart ring can be used to estimate CC depth. Comparing the two-finger and the two-thumb CC methods for infants, several studies have reported that the two-thumb CC method is more effective [ 18 , 19 ]. The reason is that the two-finger method is difficult to fix the CPR posture compared to the two-thumb method.…”

New European Resuscitation Council guidelines for pediatric life support and their implications for pediatric anesthesia: An educational article

“…For infants (<1 year), only the so-called two-thumb-encircling technique with the thumbs on top of each other (Figure 2) is recommended as this is associated with a better compression quality and less fatigue than the two finger technique which is no longer advised for trained rescuers or healthcare providers. 20 Placing the thumbs on top of each other (rather than next to each other) is advised based on weak evidence suggesting a higher perfusion pressure and lesser compression of the liver. The technique for thorax compressions in older children with one or two hands has not changed.…”