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Comparison of overlapping (OP) and adjacent thumb positions (AP) for cardiac compressions using the encircling method
Jung Soo Lim1, YongCheol Cho, Seung Ryu
1Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea.
Insights
Overlapping thumb positioning (OP) for infant cardiac compressions generated higher intrathoracic pressures compared to adjacent thumb positioning (AP). OP also resulted in less volunteer fatigue during simulated cardiopulmonary resuscitation.
Area of Science:
- Pediatric Emergency Medicine
- Cardiopulmonary Resuscitation Techniques
- Medical Simulation
Background:
- Effective infant cardiopulmonary resuscitation (CPR) is critical for patient survival.
- The encircling method for infant CPR involves specific hand placements.
- Optimizing hand positioning may enhance CPR efficiency and reduce rescuer fatigue.
Purpose of the Study:
- To compare the efficiency of overlapping (OP) versus adjacent thumb positions (AP) for infant cardiac compressions using the encircling method.
- To evaluate simulated hemodynamic parameters and rescuer fatigue levels between the two techniques.
Main Methods:
- A manikin study involving 48 emergency medical technician students.
- Crossover design comparing OP and AP techniques over 5-minute chest compressions.
- Monitoring of simulated mean arterial pressure (MAP) and rescuer fatigue via Likert scale.
Main Results:
- Overlapping thumb position (OP) achieved significantly higher simulated blood pressure and pulse pressure compared to adjacent thumb position (AP).
- Rescuers reported significantly lower fatigue levels with OP versus AP at 2, 3, and 5 minutes.
- No significant differences were found in simulated heart rate, respiratory rate, or end-tidal CO2 between the techniques.
Conclusions:
- The overlapping thumb technique may generate higher intrathoracic pressures during infant CPR.
- OP demonstrated a potential advantage in reducing rescuer fatigue.
- Further validation in actual infant cardiopulmonary resuscitation scenarios is warranted.
Objectives:
The aim of this manikin study was to compare the efficiency between overlapping (OP) and adjacent thumb positions (AP) for cardiac compressions using the encircling method in infants.
Methods:
The study conducted from December 2010 to August 2011 involved 48 volunteers who were students in the emergency medical technician course. The authors let volunteers practice OP and AP as a crossover design. The authors monitored the simulated mean arterial pressure (MAP) generated during a 5-min chest compression. The fatigue level of the volunteers after the chest compression was evaluated with the Likert scale.
Results:
There were no significant differences in MAP between the dominant hand and the non-dominant hand as the lower thumb of OP. Significant differences were observed in simulated systolic blood pressure, MAP and simulated pulse pressure between OP and AP at 1, 2, 3, 4 and 5 min. There were no significant differences among the changes in heart rate, respiratory rate and end-tidal CO(2) during a 5-min chest compression by OP and AP. The Likert scale scores (1 no fatigue to 5 = extreme fatigue) during the 5-min chest compressions were higher in AP than in OP at 2, 3 and 5 min.
Conclusion:
Higher intrathoracic pressures were achieved by OP in this study. However, further studies are needed to validate these effects of overlapping thumbs technique in infant cardiopulmonary resuscitation, not manikin.
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