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Updated: Mar 8, 2026
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover
Jacek Smereka, Mariusz Kasiński, Adam Smereka
1Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland, Poland. lukasz.szarpak@gmail.com.
Insights
A new two-thumb technique for infant cardiopulmonary resuscitation (CPR) yielded superior chest compression (CC) rates and depth compared to standard methods. This novel approach aligns with European Resuscitation Council guidelines for infant CPR quality.
Area of Science:
- Pediatric Emergency Medicine
- Cardiopulmonary Resuscitation Techniques
- Resuscitation Science
Background:
- Infant sudden cardiac arrest (SCA) etiology differs from adults, primarily involving respiratory failure, SIDS, and drowning.
- High-quality chest compressions (CC) are critical for effective cardiopulmonary resuscitation (CPR) in infants, as per ERC and AHA guidelines.
- Current guidelines recommend the two-finger technique (TFT) or two-thumb encircling hands technique (TTHT) for infant CCs.
Purpose of the Study:
- To evaluate the quality of chest compressions during simulated infant resuscitation.
- To compare the effectiveness of the traditional two-finger technique (TFT), two-thumb encircling hands technique (TTHT), and a novel two-thumb technique (nTTT).
Main Methods:
- A randomized crossover manikin trial involving 120 experienced paramedics.
- Participants performed CCs using TFT, TTHT, and the novel nTTT.
- The nTTT involves using two thumbs at a 90-degree angle to the chest with closed fists.
Main Results:
- The nTTT achieved the highest percentage of CCs within the recommended ERC frequency (100-120 min-1).
- CC depth was significantly greater with TTHT and nTTT compared to TFT.
- Adequate CC depth was achieved with both TTHT and nTTT, with nTTT showing the largest proportion of complete chest decompression.
Conclusions:
- The novel two-thumb technique (nTTT) results in a higher percentage of CCs at the recommended frequency compared to standard methods.
- The nTTT facilitates optimal CC depth, improving resuscitation quality in simulated infant CPR.
- This technique offers a promising advancement for infant CPR effectiveness.
Background:
The aetiology of sudden cardiac arrest in infants is different from that in adults, with respiratory failure, sudden infant death syndrome, and drowning being the primary causes in the former. According to the European Resuscitation Council (ERC) and American Heart Association (AHA) recommendations, the quality of chest compressions (CC) is a key element affecting the effectiveness of cardiopulmonary resuscitation (CPR). The current ERC and AHA guidelines recommend the 'two-finger technique' (TFT) or 'two-thumb encircling hands technique' (TTHT) for external CCs during infant CPR.
Aim:
The aim of the randomised crossover manikin trial was to assess the CC quality during simulated resuscitation in infants performed by paramedics.
Methods:
A prospective, randomised, crossover, single-centre study was conducted between June and August 2016. The study material consisted of 120 fully trained and licensed paramedics (39 females, 32.5%) with a minimum of five years of professional experience (mean 7.5 ± 4.8 years) in emergency medicine (mean age, 30.5 ± 5.5 years). The participants performed CCs using three techniques: TFT (the rescuer compresses the sternum with the tips of two fingers); TTHT; and the 'new two-thumb technique' (nTTT). The novel method of CCs in an infant consists of using two thumbs directed at the angle of 90 degrees to the chest while closing the fingers of both hands in a fist.
Results:
The median CC rate when using the TFT, the TTHT, and nTTT methods varied and amounted to 134 min-1 vs. 126 min-1 vs. 114 min-1, respectively. There was a statistically significant difference in the median CC frequency between TFT and TTHT (p < 0.001), TFT and nTTT (p < 0.001), and between TTHT and nTTT (p < 0.001). The highest percentage of compressions with the frequency recommended by the ERC guidelines (100-120 min-1) was achieved by the study participants only with the nTTT. The median CC depth during the TFT was 28 mm (interquartile range [IQR] 27-30 mm) and was significantly lower than in the static TTHT (40.5 [IQR 39-41] mm; p < 0.001) and nTTT (40 [IQR 39-41] mm; p < 0.001). The percentage of adequate depth CCs was correctly obtained with TTHT and nTTT. The largest proportion of total decompression of the chest was observed with the nTTT technique (96 [IQR 96-98] %), followed by TFT (95.5 [IQR 85.5-99] %) and TTHT (5 [IQR 3-7] %). In all scenarios, the correct placement of the CC point was achieved in more than 90% of cases.
Conclusions:
Our novel infant CC method provides the highest percentage of CCs with the frequency recommended by the ERC guidelines as compared with standard techniques. It also allows optimal CC depth.
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