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

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.