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Comparing the Two-finger versus Two-thumb Technique for Single Person Infant CPR: A Systematic Review and Meta-Analysis.

Abstract

INTRODUCTION

Current guidelines recommend that single person cardiopulmonary resuscitation (CPR) on an infant should be performed with two-fingers just below the inter-mammillary line with the hand clenched, while two-person CPR should be performed with two-thumbs with the hands encircling the chest. Those recommendations are based on literature that demonstrates higher quality chest compressions with the two-thumb technique, with concerns that this technique may compromise ventilation parameters when performed by the single rescuer. The purpose of this study is to compare the two compression techniques' performance during CPR using both compression and ventilation parameters.

METHODS

We performed a systematic review and meta-analysis of literature identified through a search of PubMed and One-Search comparing the quality of chest compressions and ventilation parameters between the two-thumb and two-finger techniques (Prospero registration # CRD42018087672).

RESULTS

We identified 20 manuscripts examining single person infant CPR that met study criteria, with 16 that included data suitable for meta-analysis. All of the studies included in the analysis were performed on a standardized manikin. Overall, the two-thumb technique resulted in a mean difference of 5.61 mm greater compression depth compared to the two-finger technique, with 36.91% more compressions of adequate depth per national guidelines. Interestingly, ventilation parameters did not differ between the two techniques.

CONCLUSION

While recognizing that the results of this review may differ from actual clinical experience due to the lack of fidelity between manikins and actual human infants, this systematic review with meta-analysis demonstrates that when CPR is performed on a simulated infant manikin by a single rescuer, the two-thumb technique with hands encircling the chest improves chest compression quality and does not appear to compromise ventilation.

Authors+Show Affiliations

Department of Emergency Medicine, Johns Hopkins University School of Medicine, United States. Electronic address: mmillin2@jhmi.edu.Research Assistant and PhD Candidate, Department of Preventative Medicine, Keck School of Medicine, University of Southern California, United States.Department of Emergency Medicine - Division of Pediatric Emergency Medicine, University of Florida College of Medicine - Jacksonville, United States.Department of Preventive Medicine, Keck School of Medicine, University of Southern California, United States.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31972228

Citation

Millin, Michael G., et al. "Comparing the Two-finger Versus Two-thumb Technique for Single Person Infant CPR: a Systematic Review and Meta-Analysis." Resuscitation, 2020.
Millin MG, Bogumil D, Fishe JN, et al. Comparing the Two-finger versus Two-thumb Technique for Single Person Infant CPR: A Systematic Review and Meta-Analysis. Resuscitation. 2020.
Millin, M. G., Bogumil, D., Fishe, J. N., & Burke, R. V. (2020). Comparing the Two-finger versus Two-thumb Technique for Single Person Infant CPR: A Systematic Review and Meta-Analysis. Resuscitation, doi:10.1016/j.resuscitation.2019.12.039.
Millin MG, et al. Comparing the Two-finger Versus Two-thumb Technique for Single Person Infant CPR: a Systematic Review and Meta-Analysis. Resuscitation. 2020 Jan 20; PubMed PMID: 31972228.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparing the Two-finger versus Two-thumb Technique for Single Person Infant CPR: A Systematic Review and Meta-Analysis. AU - Millin,Michael G, AU - Bogumil,David, AU - Fishe,Jennifer N, AU - Burke,Rita V, Y1 - 2020/01/20/ PY - 2019/09/08/received PY - 2019/12/22/revised PY - 2019/12/31/accepted PY - 2020/1/24/entrez PY - 2020/1/24/pubmed PY - 2020/1/24/medline KW - Cardiopulmonary Resuscitation KW - Cerebral Vascular Circulation KW - Compression Depth KW - Infant KW - Pulmonary Ventilation KW - Systematic Review JF - Resuscitation JO - Resuscitation N2 - INTRODUCTION: Current guidelines recommend that single person cardiopulmonary resuscitation (CPR) on an infant should be performed with two-fingers just below the inter-mammillary line with the hand clenched, while two-person CPR should be performed with two-thumbs with the hands encircling the chest. Those recommendations are based on literature that demonstrates higher quality chest compressions with the two-thumb technique, with concerns that this technique may compromise ventilation parameters when performed by the single rescuer. The purpose of this study is to compare the two compression techniques' performance during CPR using both compression and ventilation parameters. METHODS: We performed a systematic review and meta-analysis of literature identified through a search of PubMed and One-Search comparing the quality of chest compressions and ventilation parameters between the two-thumb and two-finger techniques (Prospero registration # CRD42018087672). RESULTS: We identified 20 manuscripts examining single person infant CPR that met study criteria, with 16 that included data suitable for meta-analysis. All of the studies included in the analysis were performed on a standardized manikin. Overall, the two-thumb technique resulted in a mean difference of 5.61 mm greater compression depth compared to the two-finger technique, with 36.91% more compressions of adequate depth per national guidelines. Interestingly, ventilation parameters did not differ between the two techniques. CONCLUSION: While recognizing that the results of this review may differ from actual clinical experience due to the lack of fidelity between manikins and actual human infants, this systematic review with meta-analysis demonstrates that when CPR is performed on a simulated infant manikin by a single rescuer, the two-thumb technique with hands encircling the chest improves chest compression quality and does not appear to compromise ventilation. SN - 1873-1570 UR - https://www.unboundmedicine.com/medline/citation/31972228/Comparing_the_Two-finger_versus_Two-thumb_Technique_for_Single_Person_Infant_CPR:_A_Systematic_Review_and_Meta-Analysis L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(20)30023-X DB - PRIME DP - Unbound Medicine ER -