Hand position during chest compression in infantile piglets – Do you need to encircle the chest with the 2-thumb-technique?

Abstract

Background

The Pediatric Life Support Consensus on Science With Treatment Recommendations states that chest compressions (CC) be performed with the 2-thumb-encircling and if the chest can not be encircled the 2-finger-technique.

Aim

To compare the hemodynamic effects of four different compression methods during CC in a piglet model of infant asphyxia.

Methods

Nine asphyxiated infant piglets were randomized to CC with 2-thumb-encircling, 2-thumb-, 2-finger-, and one-hand-techniques for one minute at each technique. CC were performed manually while hemodynamic parameters were continuously measured.

Results

Nine infantile piglets (age 5–10 days, weight 2.1–3.0 kg) were included in the study. The 2-thumb-technique and 2-thumb-encircling technique both had a significantly higher mean (SD) ejection fraction of 52.6 (31.2)% and 64.4 (30.6)% compared to the one-hand-technique with 26.6 (15.1)% (p = 0.005). The 2-thumb-encircling technique also had a significantly higher ejection fraction compared to the 2-finger-technique with values of 64.4 (30.6)% and 30.4 (12.1)%, respectively (p = 0.005). Furthermore, 2-thumb-technique and 2-thumb-encircling technique produced significantly higher carotid blood flow and dp/dt_max, and significantly lower dp/dt_min compared to the one-hand- and 2-finger-techniques.

Conclusion

The 2-thumb- and 2-thumb-encircling-techniques produced significantly higher ejection fraction, carotid blood flow, and dp/dt_max, and lower dp/dt_min compared to the 2-finger- and one-hand-techniques. Encircling the chest during the 2-thumb-technique produces similar hemodynamic effects compared to the 2-thumb-technique without encircling.