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Two-thumb-encircling advantageous for lay responder infant CPR: a randomised manikin study
  1. Jeffrey L Pellegrino1,
  2. David Bogumil2,
  3. Jonathan L Epstein3,
  4. Rita V Burke2
  1. 1 Health Sciences, Aultman College of Nursing and Health Sciences, Canton, Ohio, USA
  2. 2 Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  3. 3 American Red Cross, Washington, District of Columbia, USA
  1. Correspondence to Dr Jeffrey L Pellegrino, Health Sciences, Aultman College of Nursing and Health Sciences, Canton, OH 44710, USA; jeffrey.pellegrino{at}


Objective Paediatric health providers and educators influence infant mortality through advocacy and training within families and communities. This research sought to establish the efficacy and training of two-finger versus two-thumb-encircling techniques for lone responder infant chest compressions with ventilations in initially trained infant caregivers.

Design This is a randomised, cross-over educational intervention assessed on instrumented manikins using the 2015 guideline measures of quality infant cardiopulmonary resuscitation (CPR). Additional subjective data on the experience were collected through self-reporting.

Setting Non-healthcare community organisations and secondary school classrooms.

Participants Fourteen years or older, fluent in English and had not taken infant CPR in the last 5 years.

Interventions Groups of eight participants were randomised to learn one technique, practised and then tested for 8 min. After a 30 min rest, the group repeated the process using the other technique.

Main outcome measures Mean chest compression depth and rate, compression fraction, and correct hand position; tiredness and pain as reported by the caregiver.

Results The two-thumb-encircling technique achieved a deeper mean compression depth over the 8 min period (2.0 mm, p<0.01), closer to the minimum recommendation of 40 mm; the two-finger technique achieved higher percentages of compression fraction and complete recoil. Caregivers preferred the two-thumb technique (64%), and of these 70% had long fingernails.

Conclusions The two-thumb-encircling technique improved compression depth, over an 8 min scenario, and was preferred by caregivers. This adds to the existing literature on the advantages of two-thumb-encircling as a technique for lone and team infant CPR, which counters current guidelines.

  • comm child health
  • measurement
  • medical education
  • resuscitation
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  • Contributors JLP takes responsibility for the integrity of the work as a whole, including data collection, initial draft and revisions of the manuscript. DB provided substantial contributions to the analysis and interpretation of data. JLE, JLP and RVB provided substantial contributions to the conception and design of the work, as well as interpretation and reporting. All authors had access to all original data, participated in the drafting, approved the current version and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The Aultman Hospital Institutional Review Board (Canton, Ohio, USA) approved the protocols in January 2017.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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