Aims The 2010 International Liaison Committee of Resuscitation (ILCOR) guidelines highlighted the need to perform quality chest compressions during paediatric cardiopulmonary resuscitation to improve current outcomes. The guidelines emphasised infant chest compression target rates of 100–120 cpm, depths of 4cm and complete release. This study aims to determine the performance of two-thumb (TT) and two-finger (TF) chest compressions against these guideline targets.
Methodology A randomised, cross-over study was designed to investigate rescuer performance during TT and TF chest compressions. 12 certified advanced paediatric life support instructors performed each technique for 2 min on a commercially available infant CPR training manikin. The manikin was instrumented with a linear potentiometer, allowing the measurement of anteroposterior chest deflections. Participants were instructed to perform continuous compressions, without ventilations, and neither technique was refreshed or coached. Chest compression rates (CR), depths (CD) and residual leaning depths (remaining depth during chest release phase; LD) were recorded. Normalised performance scores were developed quantifying how accurately (ACR, ACD, ALD) and consistently (CCR, CCD, CLD) individuals performed each target relative to the ILCOR guidelines. Overall individual performance scores (ACPR, CCPR) were averaged from their respective scores, and mean scores describe cohort performance. Scores ≤1 indicate that chest compressions were more comparable to the guideline targets. Shapiro-Wilk tests evaluated distribution normality and results were statistically compared using paired parametric (paired Student's t test) or non-parametric (Wilcoxon signed rank test) tests.
Results Performance scores for each technique are presented in figure 1. Relatively poor accuracy scores are demonstrated by both techniques, with the exception of TF technique leaning depths. While it can be observed that TT chest compressions were performed with greater accuracy (ACPR: 1.70 vs 1.85) and consistency (CCPR: 0.74 vs 0.90) than TF chest compressions, neither technique was performed to ILCOR guidelines.
Conclusions The performance of the TT technique showed a greater compliance with the 2010 ILCOR guidelines than the TF technique; however, guideline targets were rarely met by either technique. The results of this manikin-based study indicate that there is a need to improve the accuracy of both chest compression techniques during infant CPR, which could potentially improve survivability.