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.

Keywords: Chest Compression; Hand position; Infant; Pediatric; Resuscitation.

Fig. 1

Chest compression techniques: (A) 2-thumb-encircling techniques, (B) 2-thumb-without encircling-technique, (C) 2-finger-technique, (D) One-hand-technique.

Fig. 2

Systolic and diastolic blood pressure and carotid blood flow with all four hand positions. Each bar represents mean and SD from 9 pigs. *Significantly different from one-hand-technique (p < 0.05, Tukey).

Fig. 3

Stroke volume, ejection fraction, maximal rate of rise of left ventricular pressure (dp/dt_max), and minimum rate of change of ventricular pressure (dp/dt_min) with all four hand positions. Each bar represents mean and SD from 9 pigs. *Significantly different from one-hand-technique; # significantly different from 2-finger-technique (P < 0.05, Tukey).