Two-thumb vs two-finger chest compression in an infant model of prolonged cardiopulmonary resuscitation

Objective: Previous experiments in the authors' swine lab have shown that c ardiopulmonary resuscitation (CPR) using two-thumb chest compression with a thoracic squeeze (TT) produces higher blood and perfusion pressures when c ompared with the American Heart Association (AHA)-recommended two-finger (T F) technique. Previous studies were of short duration (1-2 minutes). The hy pothesis was that TT would be superior to TF during prolonged CPR in an inf ant model. Methods: This was a prospective, randomized crossover experiment in a laboratory setting. Twenty-one AHA-certified rescuers performed basic CPR for two 10-minute periods, one with TT and the other with TF. Trials w ere separated by 2-14 days, and the order was randomly assigned. The experi mental circuit consisted of a modified manikin with a fixed-volume arterial system attached to a neonatal monitor via an arterial pressure transducer. The arterial circuit was composed of a 50-mL bag of normal saline solution (air removed) attached to the manikin chest plate and connected to the tra nsducer with a 20-gauge intravenous catheter and tubing. Rescuers were blin ded to the arterial pressure tracing. Systolic blood pressure (SBP), diasto lic blood pressure (DBP), and mean arterial pressure (MAP) were recorded in mm Hg, and pulse pressures (PPs) were calculated. Data were analyzed with two-way repeated-measures analysis of variance. Sphericity assumed modeling , with Greenhouse-Geisser and Huynh-Feldt adjustments, was applied. Results : Marginal means for TT SBP (68.9), DBP (17.6), MAP (35.3), and PP (51.4) w ere higher than for TF SBP (44.8), DBP (12.5), MAP (23.3), and PP (32.2). A ll four :pressures were significantly different between the two techniques (p less than or equal to 0.001). Conclusion: In this infant CPR model, TT c hest compression produced higher MAP, SBP, DBP and PP when compared with TF chest compression during a clinically relevant duration of prolonged CPR.