Two-thumb-encircling advantageous for lay responder infant CPR: a randomised manikin study.
Archives of Disease in Childhood · 2018-07-14 · Randomised trial
Abstract
OBJECTIVE: Paediatric health providers and educators influence infant mortality through advocacy and training within families and communities. This research sought to establish the efficacy and training of two-finger versus two-thumb-encircling techniques for lone responder infant chest compressions with ventilations in initially trained infant caregivers. DESIGN: This is a randomised, cross-over educational intervention assessed on instrumented manikins using the 2015 guideline measures of quality infant cardiopulmonary resuscitation (CPR). Additional subjective data on the experience were collected through self-reporting. SETTING: Non-healthcare community organisations and secondary school classrooms. PARTICIPANTS: Fourteen years or older, fluent in English and had not taken infant CPR in the last 5 years. INTERVENTIONS: Groups of eight participants were randomised to learn one technique, practised and then tested for 8 min. After a 30 min rest, the group repeated the process using the other technique. MAIN OUTCOME MEASURES: Mean chest compression depth and rate, compression fraction, and correct hand position; tiredness and pain as reported by the caregiver. RESULTS: The two-thumb-encircling technique achieved a deeper mean compression depth over the 8 min period (2.0 mm, p<0.01), closer to the minimum recommendation of 40 mm; the two-finger technique achieved higher percentages of compression fraction and complete recoil. Caregivers preferred the two-thumb technique (64%), and of these 70% had long fingernails. CONCLUSIONS: The two-thumb-encircling technique improved compression depth, over an 8 min scenario, and was preferred by caregivers. This adds to the existing literature on the advantages of two-thumb-encircling as a technique for lone and team infant CPR, which counters current guidelines.
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