Comparison of a two-finger versus two-thumb method for chest compressions by healthcare providers in an infant mechanical model.

OBJECTIVE

To compare the two-finger versus the two-thumb method of chest compression on an infant model.

STUDY

an unblinded, prospective, cross-over experimental study.

SETTING

the metropolitan area of a city with a population of greater than 260,000.

PARTICIPANTS

pediatric medical personnel and emergency workers. Anyone unable to complete the study was excluded.

INTERVENTIONS

participants performed chest compressions on an infant mannikin for 2 min. PARTICIPANTS were randomized to use the two-finger method or the two-thumb method for the first minute. The investigators recorded the skillguide readings of green (correct), green and orange (too deep), red (wrong placement), or no light (too shallow). Sixty or more correct compressions were judged to be adequate.

RESULTS

Two hundred and nine participants completed the study. PARTICIPANTS included: 66 nurses, 45 EMTs, 38 physicians, 27 paramedics, 14 nurse's assistants/emergency department technicians, 10 firefighters, five respiratory therapists, and four students. Seventy-one percent (149/209) of participants failed to give adequate compressions by either method. Only 40 participants performed adequate compressions using the two-thumb method (95% confidence interval. 14-25%). Thirty-eight participants gave adequate compressions using the two-finger method (95% confidence interval, 13-24%). No statistically significant difference existed between the two groups (P = 0.877; the McNemar test). A statistically significant difference was found in the number of shallow compressions for each method. Forty participants (19.1%) had more than 40 compressions that were too shallow versus 15 (7.2%) using the two-thumb method (P < 0.005).

CONCLUSIONS

Medical personnel often fail to give adequate compressions. The two-thumb method was as adequate as the two-finger method. Overall, more compressions were measured as shallow with the two-finger method.