Ladny Jerzy R, Smereka Jacek, Rodríguez-Núñez Antonio, Leung Steve, Ruetzler Kurt, Szarpak Lukasz
Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland Clinursid Research Group, School of Nursing, University of Santiago de Compostela Institute of Research of Santiago (IDIS) Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela SAMID-II Network, Madrid, Spain. Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA. Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
Medicine (Baltimore). 2018 Feb;97(5):e9386. doi: 10.1097/MD.0000000000009386.
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).
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.
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.
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.
小儿心脏骤停是一种致命的紧急情况，死亡率高，常伴有永久性神经损伤，对个人和国家都是社会经济负担。本研究的目的是在婴儿人体模型中测试一种新的胸外按压（CC）技术（“双拇指-握拳”或nTTT），并与标准的双指（TFT）和双手环绕双拇指技术（TTEHT）进行比较。
这是一项前瞻性、随机、交叉人体模型研究。63名护士以随机顺序对这三种技术进行了2分钟连续胸外按压的随机序列操作。测量模拟的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和脉压（PP，SBP-DBP），单位为毫米汞柱。
nTTT产生的SBP中位数（69[四分位间距，63-74]毫米汞柱）高于TTEHT（41.5[四分位间距，39-42]毫米汞柱），（P<0.001）和TFT（26.5[四分位间距，25.5-29]毫米汞柱），（P<0.001）。nTTT时模拟的DBP中位数为20（四分位间距，19-20）毫米汞柱，TTEHT时为18（四分位间距，17-19）毫米汞柱，TFT时为23.5（四分位间距，22-25.5）毫米汞柱。TFT时的DBP显著高于TTEHT（P<0.001），TTEHT时也高于nTTT（P<0.001）。nTTT时模拟MAP的中位数为37（四分位间距，34.5-38）毫米汞柱，TTEHT时为26（四分位间距，25-26）毫米汞柱，TFT时为24.5（四分位间距，23.5-26.5）毫米汞柱。nTTT与TFT之间（P<0.001）、nTTT与TTEHT之间（P<0.001）以及TTEHT与TFT之间（P<0.001）存在统计学显著差异。61名受试者（96.8%）更喜欢nTTT而不是两种标准方法。
在我们的婴儿人体模型中，新的nTTT技术与标准胸外按压技术相比，能产生更高的SBP和MAP。nTTT似乎是TFT和TTEHT的合适替代或补充方法。
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