Quality of Three Chest Compression Techniques During Two-Rescuer Infant CPR: A Randomised Crossover Manikin Study

Abstract

Aim: To evaluate the quality and ergonomic impact of three infant chest compression techniques the two-thumb encirclingtechnique (TTHT), the cross-thumb technique (CTT), and the one-hand open-palm technique (OHT) during two-rescuer infant cardiopulmonary resuscitation (CPR) utilizing a 15:2 compression-to-ventilation ratio. Materials and Methods: This prospective, randomized, crossover simulation study included 50 registered nurses who performed three 2-minute CPR sequences on an infant manikin, each using one of the three techniques. The primary outcomes were the depth of the compression, the percentage of target-range compressions, and the chest compression fraction (CCF). Secondary outcomes encompassed compression rate, recoil, hand position accuracy, excessive compressions, fatigue, pain, perceived difficulty, and hand slippage. We used repeated-measures statistical models to look at the data. Results: Both thumb-based methods (TTHT and CTT) yielded significantly deeper compressions, elevated proportions of target-range compressions, increased CCF, and enhanced accuracy in hand positioning in comparison to OHT (all p<0.01). TTHT and CTT exhibited similar mechanical performance in all primary outcomes. However, CTT had much less fatigue, hand pain, and perceived difficulty than TTHT (all p<0.01). OHT caused shallower compressions, the lowest CCF, more over-depth compressions, and the highest rate of hand slippage. Conclusion: During two-rescuer infant resuscitation, TTHT and CTT are better than OHT at biomechanical CPR quality. CTT has the same compression quality as TTHT but is more comfortable to use, making it a good choice when thumb-based techniques are feasible. OHT should only be used when it is not possible to wrap the chest. More clinical studies are needed to support these simulation results.