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Updated: Jun 24, 2026
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Effect of alternative chest compression techniques in infant and child on rescuer performance
Jai P Udassi1, Sharda Udassi, Douglas W Theriaque
1University of Florida, Gainesville, FL, USA.
Insights
The two-thumb technique for infant chest compressions (CC) provides better depth and pressure than the two-finger method. For child CC, one-hand and two-hand techniques showed no significant difference in quality or fatigue.
Area of Science:
- Cardiology
- Emergency Medicine
- Pediatric Resuscitation
Background:
- Current infant chest compression (CC) guidelines recommend two-finger (TF) technique for lone rescuers and two-thumb (TT) for two rescuers.
- Child CC guidelines suggest one-hand (OH) or two-hand (TH) techniques.
- The impact of these techniques on compression quality and rescuer fatigue at a 30:2 compression:ventilation ratio is not well understood.
Purpose of the Study:
- To compare the effectiveness of TT versus TF techniques for infant CC.
- To compare the effectiveness of OH versus TH techniques for child CC.
- To evaluate rescuer fatigue associated with different lone rescuer CC techniques.
Main Methods:
- A randomized observational study was conducted at a pediatric hospital.
- Adult healthcare providers performed 5 minutes of lone rescuer 30:2 cardiopulmonary resuscitation using modified manikins.
- Data on compression depth (CD), compression pressure (CP), and compression rate were digitally recorded; rescuer heart rate (HR) and respiratory rate were monitored for fatigue assessment.
Main Results:
- The TT technique yielded significantly higher CD and peak CP compared to TF (p < 0.001), with no decay in quality over time.
- No significant differences in CD or CP were observed between OH and TH techniques.
- While TT showed a greater increase in rescuer HR (p=0.04), overall fatigue and recovery time did not differ significantly between infant techniques.
Conclusions:
- The two-thumb technique is superior to the two-finger technique for infant chest compressions, offering better quality without increased fatigue.
- Current guidelines for child chest compressions using one-hand or two-hand techniques are supported, as neither showed a significant difference in quality or fatigue.
- The two-thumb technique is recommended for infant CC.
Objective:
Current chest compression (CC) guidelines for an infant recommend a two-finger (TF) technique with lone rescuer and a two- thumb (TT) technique with two rescuers, and for a child either an one hand (OH) or a two hand (TH) technique with one or two rescuers. The effect of a 30:2 compression:ventilation ratio using these techniques on CC quality and rescuer fatigue is unknown. We hypothesized that during lone rescuer CC, TT technique, in infant and TH in child achieve better compression depth (CD) without additional rescuer fatigue compared with TF and OH, respectively.
Design:
Randomized observational study.
Setting:
University-affiliated pediatric hospital.
Subjects:
Adult healthcare providers certified in basic life support or pediatric advanced life support.
Interventions:
Laerdal baby advanced life support trainer and Resusci junior manikin were modified to digitally record CD, compression pressure (CP) and compression rate. Sixteen subjects were randomized to each of the four techniques to perform 5 minutes of lone rescuer 30:2 compression:ventilation cardiopulmonary resuscitation. Rescuer heart rate (HR) and respiratory rate were recorded continuously and the recovery time interval for HR/respiratory rate to return to baseline was determined. Subjects were blinded to data recording. Groups were compared using two-sample, two-sided Student's t tests.
Measurements And Main Results:
Two-thumb technique generated significantly higher CD and peak CP compared with TF (p < 0.001); there was no significant difference between OH vs. TH. TF showed decay of CD and CP over time compared with TT. Compression rate (per minute) and actual compressions delivered were not significantly different between groups. No significant differences in fatigue and recovery time were observed, except the TT group had greater increase in the rescuer's HR (bpm) from baseline compared with TF group (p = 0.04).
Conclusions:
Two-thumb compression provides higher CD and CP compared with TF without any evidence of decay in quality and additional rescuer fatigue over 5 minutes. There was no significant difference in child CC quality or rescuer fatigue between OH and TH. Two-thumb technique is preferred for infant CC and our data support the current guidelines for child CC.
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