285 New Chest Compression Method in Infant Resuscitations

Abstract

For infants, cardiopulmonary resuscitation (CPR) guidelines recommend two-finger (2F) chest compression with a single rescuer and two-thumb encircling (2T) method with two rescuer. Two-thumb makes better chest compression compared with two-finger method but is increased ventilation hands-off time. To overcome the disadvantages of these two methods, we created the new method, cross-thumb (CT) compression. We investigated whether the cross-thumb compression is effective compared with two standard methods of the 2F and the 2T. Fifty-seven emergency and pediatric residents were randomly assigned into three groups. Participants were already trained pediatric basic life support programs. They performed 2 minutes of lone rescuer 30:2 compression:ventilation CPR using LaerdalTM manikin (Resusci® Baby QCPR) and answered a short questionnaire about difficulty level, fatigue strength and pain of hands using a numeric rating scales (NRS) from 1 to 10 at the end of study. The parameters of CPR were recorded by Resusci® Baby QCPR. Differences of CPR parameters between groups were assessed using the analysis of vairance (Kruskal-Wallis test) and a p-value below 0.05 was considered as statistically significance. Post-test was performed after correcting by Bonferroni correction. The mean rates of chest compression per a minute were not different among the groups, with 109.4 ± 6.1 in 2F, 110.8 ± 9.9 in 2T and 110.9 ± 8.2. The depth of compression in 2T was extremely shallower compared with other two methods (39.0 ± 2.7 mm in 2F, 42.2 ± 1.0 mm in 2T and 42.3 ± 2.9 mm in CT, p=0.00). After the post-hoc analysis, 2T and CT method could compress deeper than 2F and there were no statistically difference between 2T and CT. The mean percentage of accurate location of chest compression during 5 cycles CPR showed higher in CT, 94.6 ± 13.0% (84.0 ± 30.5% in 2F and 86.7 ± 28.1% in 2T) but the result had no significance (p=0.81). Statistically significant differences in the mean of hands-off time were observed (p=0.01). The time was shorter in 2F method (5.9 ± 1.2 sec) than others. No difference was between 2T and CT (7.5 ± 2.1 sec, 7.0 ± 1.3 sec, respectively). The difficulty level of compression methods were not different. Participants answered more tired and painful with 2F (p=0.00, p=0.00 respectively). The mean of NRS for fatigue strength were 6.9 in 2F, 4.6 in 2T and 4.0 in CT. The mean of NRS for pain of hands were 7.2 in 2F, 4.3 in 2T and 4.4 in CT. But there were no difference of fatigue and pain between 2T and CT. 2T and CT methods can compress stronger and also less tiring and less painful compared with 2F method. CT showed a trend of correct hand position upon chest wall compared with other two method. Although hand-off time was slightly longer during 2T and CT than 2F, the gap of time was not problematic rather than other studies. CT compression might consider a new method for a lone rescuer in infant CPR.