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Two-thumb versus two-finger chest compression during CRP in a swine infant model of cardiac arrest
J J Menegazzi1, T E Auble, K A Nicklas
1Division of Emergency Medicine, University of Pittsburgh School of Medicine, Pennsylvania.
Insights
The two-thumb chest compression technique significantly improves arterial and coronary perfusion pressures compared to the two-finger method in infant cardiac arrest models. This finding suggests a potentially more effective approach for pediatric resuscitation efforts.
Area of Science:
- Pediatric Resuscitation
- Cardiovascular Physiology
- Emergency Medicine
Background:
- Current American Heart Association guidelines recommend the two-finger method for infant chest compressions.
- The effectiveness of different chest compression techniques in achieving adequate perfusion pressures during infant CPR remains an area of active research.
Purpose of the Study:
- To compare the efficacy of the two-thumb chest compression technique versus the two-finger method in generating arterial and coronary perfusion pressures.
- To test the hypothesis that the two-thumb method is superior to the two-finger method in a pediatric model of cardiac arrest.
Main Methods:
- A randomized, crossover experimental trial was conducted using seven swine infants.
- Chest compressions were performed using either the two-finger or two-thumb method, with subsequent crossover.
- Arterial and coronary perfusion pressures were measured and analyzed during simulated cardiopulmonary resuscitation (CPR).
Main Results:
- The two-thumb thoracic squeeze technique resulted in significantly higher systolic blood pressure (59.4 vs 41.6 mm Hg), diastolic blood pressure (21.8 vs 18.5 mm Hg), mean arterial pressure (34.2 vs 26.1 mm Hg), and coronary perfusion pressure (15.1 vs 12.2 mm Hg) compared to the two-finger method (P < .001).
Conclusions:
- The two-thumb method of chest compression demonstrates superior performance in generating critical hemodynamic pressures during infant CPR.
- These findings support the potential adoption of the two-thumb technique as a more effective resuscitation strategy in pediatric cardiac arrest.
Study Objective:
To test the hypothesis that two-thumb chest compression generates higher arterial and coronary perfusion pressures than the current American Heart Association-approved two-finger method.
Design:
Randomized, crossover experimental trial.
Setting And Participants:
Animal laboratory experiment with seven swine of either sex weighing 9.4 kg (SD, 0.8 kg), representing infants less than 1 year old.
Interventions:
Animals were sedated with IM ketamine/xylazine, intubated with a 6.0 Hi-Lo endotracheal tube, anesthetized with alpha-chloralose, and paralyzed with pancuronium. ECG was monitored continuously. Left femoral arterial and Swan-Ganz catheters were placed. Cardiac arrest was induced with an IV bolus of KCl and verified by ECG and pressure tracings. Five American Heart Association-certified basic rescuers were randomly assigned to perform external chest compressions for one minute by either the currently recommended two-finger method or the two-thumb and thorax-squeeze method. After all five completed their first trial, rescuers crossed over to the other method for a second minute of compressions. Ventilation was performed with a bag-valve device, and no drugs were given during CPR. After three complete cycles, the fourth through sixth cycles of compressions were recorded. Every compression was analyzed for arterial systolic, diastolic, mean, and coronary perfusion pressures. One thousand fifty compressions were analyzed with repeated-measures analysis of variance and Scheffé multiple comparisons.
Results:
Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and coronary perfusion pressure were all significantly higher (P < .001) with the two-thumb thoracic squeeze technique: systolic blood pressure, 59.4 versus 41.6 mm Hg; diastolic blood pressure, 21.8 versus 18.5 mm Hg; mean arterial pressure, 34.2 versus 26.1 mm Hg; and coronary perfusion pressure, 15.1 versus 12.2 mm Hg.
Conclusion:
The two-thumb method of chest compression generates significantly higher arterial and coronary perfusion pressures than the two-finger method in this infant model of cardiac arrest.