Vol 26, No 6 (2019)
Original articles — Clinical cardiology
Published online: 2018-08-24

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Comparison of two infant chest compression techniques during simulated newborn cardiopulmonary resuscitation performed by a single rescuer: A randomized, crossover multicenter trial

Jacek Smereka1, Marcin Madziala2, Lukasz Szarpak2
Pubmed: 30155866
Cardiol J 2019;26(6):761-768.

Abstract

Background: In newborns, ventilation is a key resuscitation element but optimal chest compression
(CC) improves resuscitation quality. The study compared two infant CC techniques during simulated
newborn resuscitation performed by nurses.
Methods: The randomized crossover manikin, multicenter trial involved 52 nurses. They underwent
training with two CC techniques: standard two-finger technique (TFT) and novel two-thumb technique
(NTTT; two thumbs at 90° to the chest, fingers in a fist). One week later, the participants performed
resuscitation with the two techniques. A Tory® S2210 Tetherless and Wireless Full-term Neonatal Simulator
was applied, with a 3:1 compression to ventilation ratio. CC quality in accordance with the 2015
American Heart Association guidelines was assessed during the 2-min resuscitation.
Results: Median CC depth was 30 mm for TFT and 37 mm for NTTT (p = 0.002). Correct hand
placement reached 98% in both techniques; full chest relaxation was obtained in 97% vs. 94% for TFT
and NTTT, respectively. CC fraction was slightly better for NTTT (74% vs. 70% for TFT; p = 0.044),
the ventilation volume was comparable for both techniques. On a 100-degree scale (1 — no fatigue;
100 — extreme fatigue), the participant tiredness achieved 72 points (IQR 61–77) for TFT vs. 47 points
(IQR 40–63) for NTTT (p = 0.034). For real resuscitation, 86.5% would choose NTTT and
13.5% TFT.
Conclusions: The NTTT technique proved superior to TFT. Evidence suggests that NTTT offers
better CC depth in various medical personnel groups. One-rescuer TFT quality is not consistent with
resuscitation guidelines.

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References

  1. Atkins DL, Everson-Stewart S, Sears GK, et al. Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Circulation. 2009; 119(11): 1484–1491.
  2. Telec W, Klosiewicz T, Zalewski R, et al. Chain of survival used for a victim of sudden cardiac arrest in a public place. Disaster Emerg Med J Disaster Emerg Med J. 2017; 2(3): 135–136.
  3. Atkins D, Berger S, Duff J, et al. Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015; 132(18 suppl 2): S519–S525.
  4. Wyllie J, Bruinenberg J, Roehr CC, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth. Resuscitation. 2015; 95: 249–263.
  5. Freund B, Kaplan PW. A review of the utility of a hypothermia protocol in cardiac arrests due to non-shockable rhythms. Cardiol J. 2017; 24(3): 324–333.
  6. Treptau J, Ebnet J, Akin M, et al. Angiographic detection of fatal acute aortic dissection Stanford type A under resuscitation. Cardiol J. 2016; 23(6): 620–622.
  7. Sutton RM, Wolfe H, Nishisaki A, et al. Pushing harder, pushing faster, minimizing interruptions… but falling short of 2010 cardiopulmonary resuscitation targets during in-hospital pediatric and adolescent resuscitation. Resuscitation. 2013; 84(12): 1680–1684.
  8. Czekajlo M, Dabrowska A. In situ simulation of cardiac arrest. Disaster Emerg Med J. 2017; 2(3): 116–119.
  9. Aleksandrowicz S, Madziala M, Iskrzycki L, et al. Performance of chest compressions with the use of the new mechanical chest compression machine lifeline arm: a randomized crossover manikin study in novice physicians. Disaster Emerg Med J. 2016; 1(1): 30–36.
  10. Udassi JP, Udassi S, Lamb MA, et al. Improved chest recoil using an adhesive glove device for active compression-decompression CPR in a pediatric manikin model. Resuscitation. 2009; 80(10): 1158–1163.
  11. Naim MY, Sutton RM, Friess SH, et al. Blood pressure- and coronary perfusion pressure-targeted cardiopulmonary resuscitation improves 24-hour survival from ventricular fibrillation cardiac arrest. Crit Care Med. 2016; 44(11): e1111–e1117.
  12. Madziala M, Sukiennik L. Knowledge of medical rescue personnel regarding advances resuscitation procedures in children. Disaster Emerg Med J. 2016; 1(1): 37–42.
  13. Houri PK, Frank LR, Menegazzi JJ, et al. A randomized, controlled trial of two-thumb vs two-finger chest compression in a swine infant model of cardiac arrest [see comment]. Prehosp Emerg Care. 1997; 1(2): 65–67.
  14. Whitelaw CC, Slywka B, Goldsmith LJ. Comparison of a two-finger versus two-thumb method for chest compressions by healthcare providers in an infant mechanical model. Resuscitation. 2000; 43(3): 213–216.
  15. Christman C, Hemway RJ, Wyckoff MH, et al. The two-thumb is superior to the two-finger method for administering chest compressions in a manikin model of neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed. 2011; 96(2): F99–F9F101.
  16. Dorfsman ML, Menegazzi JJ, Wadas RJ, et al. Two-thumb vs. two-finger chest compression in an infant model of prolonged cardiopulmonary resuscitation. Acad Emerg Med. 2000; 7(10): 1077–1082.
  17. Jiang J, Zou Y, Shi W, et al. Two-thumb-encircling hands technique is more advisable than 2-finger technique when lone rescuer performs cardiopulmonary resuscitation on infant manikin. Am J Emerg Med. 2015; 33(4): 531–534.
  18. Smereka J, Szarpak L, Smereka A, et al. Evaluation of new two-thumb chest compression technique for infant CPR performed by novice physicians. A randomized, crossover, manikin trial. Am J Emerg Med. 2017; 35(4): 604–609.
  19. Evrin T, Bielski KT. Is there any difference between different infant chest compression methods? Disaster Emerg Med J. 2017; 2(4): 173–174.
  20. Smereka J, Bielski K, Ladny JR, et al. Evaluation of a newly developed infant chest compression technique: A randomized crossover manikin trial. Medicine (Baltimore). 2017; 96(14): e5915.
  21. Smereka J, Szarpak L, Ladny JR, et al. A Novel Method of Newborn Chest Compression: A Randomized Crossover Simulation Study. Front Pediatr. 2018; 6: 159.
  22. Smereka J, Kasiński M, Smereka A, et al. The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial. Kardiol Pol. 2017; 75(6): 589–595.
  23. Smereka J, Szarpak L, Rodríguez-Núñez A, et al. A randomized comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: A randomized manikin study. Am J Emerg Med. 2017; 35(10): 1420–1425.
  24. Ladny JR, Smereka J, Rodríguez-Núñez A, et al. Is there any alternative to standard chest compression techniques in infants? A randomized manikin trial of the new "2-thumb-fist" option. Medicine (Baltimore). 2018; 97(5): e9386.
  25. Dellimore KH, Scheffer C, Smith J, et al. Evaluating the influence of ventilation and ventilation-compression synchronization on chest compression force and depth during simulated neonatal resuscitation. J Matern Fetal Neonatal Med. 2017; 30(11): 1255–1260.
  26. Solevåg AL, Schmölzer GM. Optimal chest compression rate and compression to ventilation ratio in delivery room resuscitation: evidence from newborn piglets and neonatal manikins. Front Pediatr. 2017; 5: 3.
  27. Douvanas A, Koulouglioti C, Kalafati M. A comparison between the two methods of chest compression in infant and neonatal resuscitation. A review according to 2010 CPR guidelines. J Matern Fetal Neonatal Med. 2018; 31(6): 805–816.
  28. Friess SH, Sutton RM, French B, et al. Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation. Resuscitation. 2014; 85(9): 1298–1303.
  29. Na JiU, Choi PC, Lee HJ, et al. A vertical two-thumb technique is superior to the two-thumb encircling technique for infant cardiopulmonary resuscitation. Acta Paediatr. 2015; 104(2): e70–e75.
  30. Jung WJ, Hwang SOh, Kim HIl, et al. 'Knocking-fingers' chest compression technique in infant cardiac arrest: single-rescuer manikin study. Eur J Emerg Med. 2018 [Epub ahead of print].
  31. Rottenberg EM. Are the current guideline recommendations for neonatal cardiopulmonary resuscitation safe and effective? Am J Emerg Med. 2016; 34(8): 1658–1660.
  32. Kim YS, Oh JeH, Kim CW, et al. Which Fingers Should We Perform Two-Finger Chest Compression Technique with When Performing Cardiopulmonary Resuscitation on an Infant in Cardiac Arrest? J Korean Med Sci. 2016; 31(6): 997–1002.
  33. Fakhraddin BZ, Shimizu N, Kurosawa S, et al. New method of chest compression for infants in a single rescuer situation: thumb-index finger technique. J Med Dent Sci. 2011; 58(1): 15–22.
  34. Martin PS, Kemp AM, Theobald PS, et al. Do chest compressions during simulated infant CPR comply with international recommendations? Arch Dis Child. 2013; 98(8): 576–581.
  35. Smereka J, Kaminska H, Wieczorek W, et al. Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial. Kardiol Pol. 2018; 76(6): 980–986.
  36. Udassi S, Udassi JP, Lamb MA, et al. Two-thumb technique is superior to two-finger technique during lone rescuer infant manikin CPR. Resuscitation. 2010; 81(6): 712–717.
  37. Boldingh AM, Jensen TH, Bjørbekk AT, et al. Rescuers' physical fatigue with different chest compression to ventilation methods during simulated infant cardiopulmonary resuscitation. J Matern Fetal Neonatal Med. 2016; 29(19): 3202–3207.
  38. Li ES, Cheung PY, O'Reilly M, et al. Rescuer fatigue during simulated neonatal cardiopulmonary resuscitation. J Perinatol. 2015; 35(2): 142–145.
  39. Enriquez D, Meritano J, Shah BA, et al. Fatigue during chest compression using a neonatal patient simulator. Am J Perinatol. 2018; 35(8): 796–800.
  40. Kaleta AM, Lewicka E, Dąbrowska-Kugacka A, et al. Intensive exercise and its effect on the heart: Is more always better? Cardiol J. 2017; 24(2): 111–116.
  41. Baik N, O'Reilly M, Fray C, et al. Ventilation strategies during neonatal cardiopulmonary resuscitation. Front Pediatr. 2018; 6: 18.
  42. Pasquin MP, Cheung PY, Patel S, et al. Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia. Neonatology. 2018; 114(1): 37–45.