Novel method of infant chest compression. Does the arrangement of the thumbs matter?

Abstract

Following the discussion [1-3] on a novel technique for chest compression in infants and newborns (nTTT), described in the American Journal of Emergency Medicine [4], we decided to examine whether the angle of chest compression in accordance with the technique affected the basic quality parameters of resuscitation. Infant chest compression with nTTT is described as follows: “the ‘new two-thumb technique’ (nTTT) of chest compressions in an infant consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist” [5]. Observing the discussion on nTTT,we paid special attention to the angle of thumbs in relation to the chestwall. Themain advantage of the new technique is that the alignment of thumbs with the arms increases the compressive force exerted on the chest, which in the case of the two-finger technique mainly depends on the muscle strength of the fingers and the whole hand. We therefore decided to compare the basic chest compression quality parameters during infant resuscitation. After receiving an approval by the Institutional Review Board of the Polish Society of DisasterMedicine (approval no.: IRBN 12.07.2018), we performed a cross-over randomized manikin study in a group of 36 paramedics. Each participant received information about the study and voluntarily agreed to participate. The subjects were to perform single-rescuer 2-min cardiopulmonary resuscitation with the use of an ALS Baby trainer manikin (Laerdal Medical, Stavanger, Norway) simulating a 3-month-old infant. In order to allow comparisonwith previous studies, the manikin was placed on a high adjustable hospital stretcher at the level of the iliac crest of each rescuer for standardization. The resuscitation was performed in accordance with the current pediatric basic life support resuscitation guidelines (15:2 chest compression to ventilation rate with the recommended 100–120 chest compressions per minute). The study involved 2 scenarios; the participants were randomly assigned to performing resuscitation with both scenarios in a randomly assigned order with a 20-min break before applying the other CPR technique. Scenario A consisted in implementing the correct nTTT chest compression technique with two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist. Scenario B included amodified nTTT techniquewith two thumbs directed at the angle of 45° instead of 90° (Fig. 1). We evaluated chest compression depth, chest compression rate, percentage of compressions with correct depth, percentage of chest compressions with the recommended rate, and percentage of complete chest relaxation. The data were analyzed with the Statistica software v.12 (StatSoft Inc., Tulsa, USA). The Research Randomizer software (www.randomizer. org) was used for randomization. The median depth (mm) of chest compression was 39 (37–40) in scenario A and 36 (35–39) in Scenario