Elsevier

Resuscitation

Volume 43, Issue 3, February 2000, Pages 213-216
Resuscitation

Comparison of a two-finger versus two-thumb method for chest compressions by healthcare providers in an infant mechanical model

https://doi.org/10.1016/S0300-9572(99)00145-8Get rights and content

Abstract

Objective: To compare the two-finger versus the two-thumb method of chest compression on an infant model. Method: Study: an unblinded, prospective, cross-over experimental study. Setting: the metropolitan area of a city with a population of greater than 260 000. Participants: pediatric medical personnel and emergency workers. Anyone unable to complete the study was excluded. Interventions: participants performed chest compressions on an infant mannikin for 2 min. Participants were randomized to use the two-finger method or the two-thumb method for the first minute. The investigators recorded the skillguide readings of green (correct), green and orange (too deep), red (wrong placement), or no light (too shallow). Sixty or more correct compressions were judged to be adequate. Results: Two hundred and nine participants completed the study. Participants included: 66 nurses, 45 EMTs, 38 physicians, 27 paramedics, 14 nurse’s assistants/emergency department technicians, 10 firefighters, five respiratory therapists, and four students. Seventy-one percent (149/209) of participants failed to give adequate compressions by either method. Only 40 participants performed adequate compressions using the two-thumb method (95% confidence interval, 14–25%). Thirty-eight participants gave adequate compressions using the two-finger method (95% confidence interval, 13–24%). No statistically significant difference existed between the two groups (P=0.877; the McNemar test). A statistically significant difference was found in the number of shallow compressions for each method. Forty participants (19.1%) had more than 40 compressions that were too shallow versus 15 (7.2%) using the two-thumb method (P<0.005). Conclusions: Medical personnel often fail to give adequate compressions. The two-thumb method was as adequate as the two-finger method. Overall, more compressions were measured as shallow with the two-finger method.

Introduction

Chest compressions are given during CPR in an attempt to produce blood flow and delivery of oxygen to vital organs. When optimally performed, chest compressions may initially sustain cerebral and coronary perfusion pressure [1]. Inadequate compressions compromise the resuscitation effort and fail to help restore or maintain perfusion.

Chest compressions on infants are performed by placing the middle and ring fingers one finger’s width below the intermammary line and compressing to a depth of 0.05–1 inch [2]. An alternate method was described and studied by Thaler and Stobie in 1963. Their technique involved superimposing the thumbs over the middle of the sternum and linking the fingers behind the back of the infant. They compared the two techniques on fresh human cadavers and found that less sternal compression force was required to achieve average systolic pressures of 100 mmHg using the two-thumb versus the two-finger method [3]. Several case reports were the only supporting evidence for the superiority of the two-thumb method [4], [5] until 1993, when Menagzzi et al. compared a modified two-thumb method of compressions with the two-finger method on seven infant swine [6]. Their method consisted of simultaneous sternal compression with the thumbs with gentle squeezing of the thorax using both hands. They concluded that this modified two-thumb method gave a significantly higher coronary perfusion pressure and mean arterial pressure. However, this study has several limitations, including using animals that were large for the two-thumb technique, not providing support for the two-finger technique, not controlling compression force, not using an asphyxial model and not providing survival outcome data. A later study, also done on immature swine, compared this modified two-thumb method with the two-finger method. This study used an asphyxial model and found that the two-thumb method gave significantly higher systolic blood pressure measurements. Rescuers were able to maintain a minimum compression force of 20 psi with the two-thumb method but not with the two-finger method [7]. A search of the English language medical literature did not reveal any further studies that supported or disputed the advantage of this method of chest compressions in an infant.

The purpose of this study was to assess the adequacy of health care provider chest compressions and to compare the two-finger method of chest compressions with the two-thumb method in an infant mannikin model. A formal statement of our research hypotheses is that a two-thumb method of chest compression provides more adequate compressions than a two-finger method.

Section snippets

Materials and methods

Subjects were recruited from emergency medical personnel who were required to have basic life support certification for their positions. Any subject unable to complete the study was excluded. Informed consent was obtained from all participants and the study was approved by the institutional review board.

Each participant performed chest compressions for 2 min on a mannikin (Resuscibaby with skillguide, Laerdal). No rescue breaths were given. The mannikin was 61 cm in length, simulating a 4–5 kg

Results

Two hundred and nine participants completed the study. Two enrollees were excluded. They were both ambulance personnel who had to respond to a call after filling out the consent form. Participants included: 66 nurses, 45 EMTs, 38 physicians, 27 paramedics, 14 nurse’s assistants/emergency department technicians, 10 firefighters, five respiratory therapists, and four students (two medical and two nursing). All participants had previously taken a basic life-support course.

Of the 209 participants,

Discussion

This study suggests that the majority of medical personnel, regardless of their training level, fail to obtain or maintain good compression skills. Instructors and resuscitation leaders should be more aware of this conclusion and make the necessary corrections to improve the efficacy of basic life support in infants. Since both methods of compressions were equally successful, personnel should be taught the method best suited to their motor skills and working environment. The firefighters, for

Summary

Medical personnel fail to give adequate compressions. The two-thumb method was as adequate as the two-finger method. Overall, more compressions were measured as shallow with the two-finger method.

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This paper was presented at the May 1998 meeting of the Society for Academic Emergency Medicine in Chicago, IL, USA.

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