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Meta-Analysis
. 2020 Jul 19;17(14):5214.
doi: 10.3390/ijerph17145214.

Two-Thumb or Two-Finger Technique in Infant Cardiopulmonary Resuscitation by a Single Rescuer? A Meta-Analysis with GOSH Analysis

Chun-Yu Chang  1 , Yueh-Tseng Hou  2   3 , Yung-Jiun Chien  4 , Yu-Long Chen  2   3 , Po-Chen Lin  2   3 , Chien-Sheng Chen  2   3 , Meng-Yu Wu  2   3
Affiliations
Meta-Analysis

Two-Thumb or Two-Finger Technique in Infant Cardiopulmonary Resuscitation by a Single Rescuer? A Meta-Analysis with GOSH Analysis

Chun-Yu Chang et al. Int J Environ Res Public Health. .

Abstract

Out-of-hospital infant cardiopulmonary arrest is a fatal and uncommon event. High mortality rates and poor neurological outcomes may be improved by early cardiopulmonary resuscitation (CPR). The ongoing debate over two different infant CPR techniques, the two-thumb (TT) and the two-finger (TF) technique, has remained, especially in terms of the adequate compression depth, compression rate, and hands-off time. In this article, we searched three major databases, PubMed, EMBASE (Excerpta Medica database), and CENTRAL (Cochrane Central Register of Controlled Trials), for randomized control trials which compared the outcomes of interest between the TT and TF techniques in infant CPR. The results showed that the TT technique was associated with higher proportion of adequate compression depth (Mean difference (MD): 19.99%; 95%, Confidence interval (CI): 9.77 to 30.22; p < 0.01) than the TF technique. There was no significant difference in compression rate and hands-off time. In our conclusion, the TT technique is better in terms of adequate compression depth than the TF technique, without significant differences in compression rate and hands-off time.

Keywords: cardiopulmonary resuscitation; chest compression; infant; two fingers; two thumbs.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Risk of bias summary and graph of chest compression rate.
Figure 3
Figure 3
Risk of bias summary and graph of proportion of adequate compression depth.
Figure 4
Figure 4
Risk of bias summary and graph of hands-off time.
Figure 5
Figure 5
Forest plot of chest compression rate, proportion of adequate compression depth, and hand-off time.
Figure 6
Figure 6
Subgroup analysis of chest compression rate grouped by locale.
Figure 7
Figure 7
Subgroup analysis of chest compression rate grouped by ventilation protocol (yes/no).
Figure 8
Figure 8
Subgroup analysis of chest compression rate grouped by ventilation protocol (15:2/30:2/no).
Figure 9
Figure 9
Subgroup analysis of chest compression rate grouped by manikin model.
Figure 10
Figure 10
Subgroup analysis of chest compression rate grouped by expertise of the participants.
Figure 11
Figure 11
Subgroup analysis of chest compression rate grouped by manikin placement.
Figure 12
Figure 12
Subgroup analysis of the proportion of adequate compression depth grouped by ventilation protocol (yes/no).
Figure 13
Figure 13
Subgroup analysis of the proportion of adequate compression depth grouped by ventilation protocol (15:2/30:2/no).
Figure 14
Figure 14
Sensitivity analysis of chest compression rate. (A) Leave-one-out analysis; (B) forest plot with the correlation set as the highest observed (0.95); (C) forest plot with the correlation set as 0.
Figure 15
Figure 15
(A,B,C) Potential outliers identified by three unsupervised learning algorithms. (D) GOSH plots with the corresponding subsets including the potential outliers colored in green. (E) Left plot: the original GOSH plot; right plot: the GOSH plot after excluding the potential outliers in the first round. (F) Baujat plot containing the remaining studies after excluding the potential outliers in the first round. (G) GOSH plots with the corresponding subsets including the potential outliers identified from the Baujat plot colored in red and dark green. (H) Forest plot after excluding all the potential outliers.
Figure 16
Figure 16
Sensitivity analysis of proportion of adequate compression depth. (A) Leave-one-out analysis. (B) The Baujat plot. (C) Left plot: the original GOSH plot; right plot: the GOSH plot after excluding the potential outliers identified from the Baujat plot. (D) GOSH plots with the corresponding subsets including the potential outliers identified from the Baujat plot colored in red and dark green. (E) Forest plot after excluding all the potential outliers.
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References

    1. Atkins D.L.S., Everson-Stewart G.K., Sears M., Daya M.H., Osmond C.R., Warden R.A. Berg. Epidemiology and Outcomes from out-of-Hospital Cardiac Arrest in Children: The Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Circulation. 2009;119:1484–1491. doi: 10.1161/CIRCULATIONAHA.108.802678. - DOI - PMC - PubMed
    1. Young K.D., Gausche-Hill M., McClung C.D., Lewis R.J. A Prospective, Population-Based Study of the Epidemiology and Outcome of out-of-Hospital Pediatric Cardiopulmonary Arrest. Pediatrics. 2004;114:157–164. doi: 10.1542/peds.114.1.157. - DOI - PubMed
    1. Tress E.E., Kochanek P.M., Saladino R.A., Manole M.D. Cardiac Arrest in Children. J. Emerg. Trauma Shock. 2010;3:267–272. doi: 10.4103/0974-2700.66528. - DOI - PMC - PubMed
    1. Atkins D.L., Berger S., Duff J.P., Gonzales J.C., Hunt E.A., Joyner B.L., Meaney P.A., Niles D.E., Samson R.A., Schexnayder S.M. Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:S519–S525. doi: 10.1161/CIR.0000000000000265. - DOI - PubMed
    1. Maconochie I.K., De Caen A.R., Aickin R., Atkins D.L., Biarent D., Guerguerian A.M., Kleinman D.A., Kloeck M.E., Meaney P.A., Nadkarni V.M., et al. Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation. 2015;95:E147–E168. - PubMed

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