Comparison of two infant chest compression techniques during simulated newborn cardiopulmonary resuscitation performed by a single rescuer: A randomized, crossover multicenter trial.

backgroundIn newborns, ventilation is a key resuscitation element but optimal chest compression (CC) improves resuscitation quality. The study compared two infant CC techniques during simulated newborn resuscitation performed by nurses.

methodsThe randomized crossover manikin, multicenter trial involved 52 nurses. They underwent training with two CC techniques: standard two-finger technique (TFT) and novel two-thumb technique (NTTT; two thumbs at 90° to the chest, fingers in a fist). One week later, the participants performed resuscitation with the two techniques. A Tory® S2210 Tetherless and Wireless Full-term Neonatal Simulator was applied, with a 3:1 compression to ventilation ratio. CC quality in accordance with the 2015 American Heart Association guidelines was assessed during the 2-min resuscitation.

resultsMedian CC depth was 30 mm for TFT and 37 mm for NTTT (p = 0.002). Correct hand placement reached 98% in both techniques; full chest relaxation was obtained in 97% vs. 94% for TFT and NTTT, respectively. CC fraction was slightly better for NTTT (74% vs. 70% for TFT; p = 0.044), the ventilation volume was comparable for both techniques. On a 100-degree scale (1 - no fatigue; 100 - extreme fatigue), the participant tiredness achieved 72 points (IQR 61-77) for TFT vs. 47 points (IQR 40-63) for NTTT (p = 0.034). For real resuscitation, 86.5% would choose NTTT and 13.5% TFT.

conclusionsThe NTTT technique proved superior to TFT. Evidence suggests that NTTT offers better CC depth in various medical personnel groups. One-rescuer TFT quality is not consistent with resuscitation guidelines.