Is there any alternative to standard chest compression techniques in infants? A randomized manikin trial of the new “2-thumb-fist” option

BACKGROUND: Pediatric cardiac arrest is a fatal emergent condition that is associated with high mortality, permanent neurological injury, and is a socioeconomic burden at both the individual and national levels. The aim of this study was to test in an infant manikin a new chest compression (CC) technique (“2 thumbs-fist” or nTTT) in comparison with standard 2-finger (TFT) and 2-thumb-encircling hands techniques (TTEHT). METHODS: This was prospective, randomized, crossover manikin study. Sixty-three nurses who performed a randomized sequence of 2-minute continuous CC with the 3 techniques in random order. Simulated systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), and pulse pressures (PP, SBP–DBP) in mm Hg were measured. RESULTS: The nTTT resulted in a higher median SBP value (69 [IQR, 63–74] mm Hg) than TTEHT (41.5 [IQR, 39–42] mm Hg), (P < .001) and TFT (26.5 [IQR, 25.5–29] mm Hg), (P <.001). The simulated median value of DBP was 20 (IQR, 19–20) mm Hg with nTTT, 18 (IQR, 17–19) mm Hg with TTEHT and 23.5 (IQR, 22–25.5) mm Hg with TFT. DBP was significantly higher with TFT than with TTEHT (P <.001), as well as with TTEHT than nTTT (P <.001). Median values of simulated MAP were 37 (IQR, 34.5–38) mm Hg with nTTT, 26 (IQR, 25–26) mm Hg with TTEHT and 24.5 (IQR,23.5–26.5) mm Hg with TFT. A statistically significant difference was noticed between nTTT and TFT (P <.001), nTTT and TTEHT (P <.001), and between TTEHT and TFT (P <.001). Sixty-one subjects (96.8%) preferred the nTTT over the 2 standard methods. CONCLUSIONS: The new nTTT technique achieved higher SBP and MAP compared to the standard CC techniques in our infant manikin model. nTTT appears to be a suitable alternative or complementary to the TFT and TTEHT.