Effect of alternative chest compression techniques in infant and child on rescuer performance
ABSTRACT Current chest compression (CC) guidelines for an infant recommend a two-finger (TF) technique with lone rescuer and a two- thumb (TT) technique with two rescuers, and for a child either an one hand (OH) or a two hand (TH) technique with one or two rescuers. The effect of a 30:2 compression:ventilation ratio using these techniques on CC quality and rescuer fatigue is unknown. We hypothesized that during lone rescuer CC, TT technique, in infant and TH in child achieve better compression depth (CD) without additional rescuer fatigue compared with TF and OH, respectively.
Randomized observational study.
University-affiliated pediatric hospital.
Adult healthcare providers certified in basic life support or pediatric advanced life support.
Laerdal baby advanced life support trainer and Resusci junior manikin were modified to digitally record CD, compression pressure (CP) and compression rate. Sixteen subjects were randomized to each of the four techniques to perform 5 minutes of lone rescuer 30:2 compression:ventilation cardiopulmonary resuscitation. Rescuer heart rate (HR) and respiratory rate were recorded continuously and the recovery time interval for HR/respiratory rate to return to baseline was determined. Subjects were blinded to data recording. Groups were compared using two-sample, two-sided Student's t tests.
Two-thumb technique generated significantly higher CD and peak CP compared with TF (p < 0.001); there was no significant difference between OH vs. TH. TF showed decay of CD and CP over time compared with TT. Compression rate (per minute) and actual compressions delivered were not significantly different between groups. No significant differences in fatigue and recovery time were observed, except the TT group had greater increase in the rescuer's HR (bpm) from baseline compared with TF group (p = 0.04).
Two-thumb compression provides higher CD and CP compared with TF without any evidence of decay in quality and additional rescuer fatigue over 5 minutes. There was no significant difference in child CC quality or rescuer fatigue between OH and TH. Two-thumb technique is preferred for infant CC and our data support the current guidelines for child CC.
Archivos argentinos de pediatría 12/2011; 109(6):536-544. DOI:10.5546/aap.2011.536 · 0.29 Impact Factor
Monatsschrift Kinderheilkunde 08/2014; 162(8):701-710. DOI:10.1007/s00112-014-3102-0 · 0.28 Impact Factor
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ABSTRACT: The process of cardiopulmonary resuscitation (CPR) involves various components that must be followed to deliver high quality of CPR. While the components commonly apply to CPR for all ages from infant to adult, there are several different suggestions for infant CPR such as two-thumb (TT) CPR and two-finger (TF) CPR. However, the comprehensive evaluation based on all these components has been difficult in the absence of proper evaluation tool. Here, we developed a new manikin-integrated, digital measuring system that objectively estimates overall performance of infant CPR by evaluating individual CPR components one by one including different hand placements. The system collects and analyzes data to present estimations in digital scores according to a new evaluation index constructed based on the previously verified one. The feasibility of the system was validated through simulations with beginners and experts in first aid, resulting in statistically significant differences between the two groups with the indication of specific weaknesses for each group which may provide a basis for creating customized CPR training strategy in compliance with the personal level. We believe that the system would become a valuable assessment tool not only for infant CPR but also for CPR technique in general by reflecting every component in the evaluation.IEEE Transactions on Information Technology in Biomedicine 11/2013; DOI:10.1109/JBHI.2013.2288641 · 2.07 Impact Factor