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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 Smereka, Marcin Madziala, Lukasz Szarpak
DOI: 10.5603/CJ.a2018.0090
·
Pubmed: 30155866

open access

Ahead of print
Original articles
Published online: 2018-08-24

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.

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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Keywords

newborn, cardiopulmonary resuscitation, chest compression, quality, medical simulation

About this article
Title

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

Journal

Cardiology Journal

Issue

Ahead of print

Published online

2018-08-24

DOI

10.5603/CJ.a2018.0090

Pubmed

30155866

Keywords

newborn
cardiopulmonary resuscitation
chest compression
quality
medical simulation

Authors

Jacek Smereka
Marcin Madziala
Lukasz Szarpak

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