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Do chest compressions during simulated infant CPR comply with international recommendations?
  1. Philip Stephen Martin1,
  2. Alison Mary Kemp2,
  3. Peter S Theobald1,
  4. Sabine A Maguire2,
  5. Michael D Jones1
  1. 1Institute of Medical Engineering & Medical Physics, Cardiff University School of Engineering, Cardiff University, Cardiff, Wales, UK
  2. 2Department of Child Health, Cardiff University School of Medicine, Cardiff University, Cardiff, Wales, UK
  1. Correspondence to Dr Michael D Jones, Institute of Medical Engineering & Medical Physics, Cardiff School of Engineering, Cardiff University, Cardiff CF24 3AA, Wales, UK; JonesMD1{at}


Background Morbidity and mortality remain high following infant cardiac arrest. Optimal cardiopulmonary resuscitation (CPR) is therefore imperative.

Objective Comparison of two-thumb (TT) and two-finger (TF) infant chest compression technique compliance with international recommendations.

Design Randomised cross-over experimental study.

Methods Twenty-two certified Advanced Paediatric Life Support (APLS) instructors performed 2 min continuous TT and TF chest compressions on an instrumented infant CPR manikin. Compression depth (CD), release force (RF), compression rate (CR) and duty cycles (DCs) were recorded. Quality indices were developed to calculate the proportion of compressions that complied with internationally recommended targets, and an overall quality index was used to calculate the proportion that complied with all four targets.

Results Mean CD was 33 mm and 26 mm (p<0.001; target ≥36.7 mm), mean RF was 0.8 kg and 0.2 kg (p<0.001; target <2.5 kg), mean CR was 128/min and 131/min (p=0.052; target 100–120/min) and mean DCs was 61% and 53% (p<0.001; target 30–50%) for the TT and TF techniques, respectively. With the exception of RF, the majority of compressions failed to comply with targets. The TT technique improved median CD compliance (6% vs 0% (p<0.001)), while the TF technique improved median DC compliance (23% vs 0% (p<0.001)). Overall compliance with all four targets was <1% for both techniques (p=0.14).

Conclusions Compliance of APLS instructors with current international recommendations during simulated infant CPR is poor. The TT technique provided improved CD compliance, while the TF technique provided superior DC compliance. If this reflects current clinical practice, optimisation of performance to achieve international recommendations during infant CPR is called for.

  • Resuscitation
  • chest compression
  • infant
  • manikins

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