Infant chest compression quality: A video-based comparison of two-thumb versus one-hand technique in the emergency department.

Aim: To use video review to compare CC quality between 2-thumb encircling (2T) and one-hand anterior (1H) hand position in infants receiving CPR.

Methods: Events where an infant received >2min of CC using a CPR monitor device while videorecorded were included. CC were measured in segments provided by a single compressor; segment duration, identity of the compressor, and hand position (2T vs 1H) was determined from video review. CC rate and depth were measured by the monitor device.

Results: Seven infants received 111min of CCs from a total of 28 providers. 12/28 providers were assessed using both 2T and 1H; 6 providers used 2T and 1H in the same patient. 80 CC segments were analyzed; the median duration of CC segments was 74s (IQR 50-95s). Median CC rate across all segments was 127/min (IQR 115-142/min); median CC depth was 3.0cm (IQR 2.4-3.4cm). 2T position was used in 33/80 (41%) of segments. There was no significant difference in CC depth between 2T and 1H position (3.0±0.8 vs 3.0±0.6cm, p=0.81). 1H position was significantly associated with faster CC rate than 2T position (134±18 vs. 118±15 CC/min, p<0.001).

Conclusions: During CC in infants, 1H position was associated with a greater prevalence of inappropriately fast CC rate compared to 2T. There was no significant difference in depth between 2T and 1H. Future studies should evaluate the effect of hand position on clinical outcomes.