Background

Current cardiopulmonary resuscitation (CPR) guidelines recommend the two fingers technique (TFT) of chest compression (CC) in infants for a single rescuer. We hypothesized that healthcare providers cannot achieve adequate CC depth with TFT even if using real-time visual feedback (RVF).

Methods

Cross-over study randomizing participants to perform 3 sets of 2-minute continuous CC, comparing TFT with RVF, the one hand technique (OHT) without RVF and OHT with RVF. A standard CPR trainer manikin simulating a 3-month-old infant and a monitor/defibrillator that displays and records the quantitative CC quality were used. We set a target compression depth as 40-50 mm and a target compression rate as 100-120/min. Data were analyzed using Friedman test and Bonferroni correction. Statistical significance was defined as p < 0.05.

Results

59 healthcare providers participated the study. The mean compression depth was 24 (interquartile range [IQR], 22-26) mm in TFT with RVF and 43 (IQR, 38-48) mm in OHT without RVF, p < 0.001. The proportion of adequate CC depth was 0 (IQR, 0-0) % in TFT with RVF, 22 (IQR, 5-54) % in OHT without RVF and 62 (IQR, 29-83) % in OHT with RVF. In any of the three techniques, the mean compression rate was within the target range.

Conclusion

TFT cannot generate the CC depth to meet the recommendation of the current CPR guidelines for infant with RVF, whereas OHT can do so.