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 c ompression on an infant model. Method: Study: an unblinded, prospective, cr oss-over experimental study. Setting: the metropolitan area of a city with a population of greater than 260 000. Participants: pediatric medical perso nnel and emergency workers. Anyone unable to complete the study was exclude d. Interventions: participants performed chest compressions on an infant ma nnikin for 2 min. Participants were randomized to use the two-finger method or the two-thumb method for the first minute. The investigators recorded t he skillguide readings of green (correct), green and orange (too deep), red (wrong placement), or no light (too shallow). Sixty or more correct compre ssions were judged to be adequate. Results: Two hundred and nine participan ts completed the study. Participants included: 66 nurses, 45 EMTs, 38 physi cians, 27 paramedics, 14 nurse's assistants/emergency department technician s, 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 us ing the two-thumb method (95% confidence interval, 14-25%). Thirty-eight pa rticipants gave adequate compressions using the two-finger method (95% conf idence interval, 13-24%). No statistically significant difference existed b etween the two groups (P=0.877; the McNemar test). A statistically signific ant difference was found in the number of shallow compressions for each met hod. 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). Conclusio ns: Medical personnel often fail to give adequate compressions. The two-thu mb method was as adequate as the two-finger method. Overall, more compressi ons were measured as shallow with the two-finger method. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.