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Best CPR Quality in Children – 1 or 2 Hands, 2 Thumbs, 2 Fingers?

May 25, 2023

Written by Joel Schirding

Spoon Feed
Using a 1-handed technique in infants <1yr and 2-handed technique in children >1yr resulted in deeper compressions, closer to AHA guideline recommendations, but compliance with rate and depth were mediocre regardless of technique.

Why does this matter?
There have been few in-vivo pediatric studies on CPR technique with the current AHA recommendations being based on adult or mannequin studies.

They failed to eat their Wheaties…
This was a multicenter prospective observational cohort study in 3 tertiary children’s hospital EDs utilizing institutionally established videography and CPR feedback devices.  Because the AHA gives providers the option to use various compression techniques (thumb-encircling chest, 2-fingers, 1-handed, and 2-handed) they hoped to see if one technique stood out as superior in meeting AHA recommendations.  Disappointingly, compressors, on average, failed to achieve the recommended depth with all techniques.  The 2-finger technique was utilized too infrequently to be statistically evaluated.  The 1-handed technique in <1yr olds came the closest to guideline recommendations (1/3-1/2 of the chest’s AP diameter or 3.6-4.4cm), achieving on average 2.87cm.  In children >1yr old, the 2-handed technique came the closest to recommendations (4.5-5.5cm), achieving an average depth of 3.96cm.  Average compression rates with the various techniques were all close to recommendations across all ages.  When total compliance to AHA PALS was evaluated, accounting for both rate and depth, the 1-handed technique in <1yr was the closest at 47% compliant.  The 2-handed technique in the 1 to 5 yr old group was only 24% compliant, and 16% in 5 to 8 yr group, still outpacing the abysmal performance of the 1-handed technique in these older age groups.  

Peer Reviewed by Dr. Ketan Patel

The effect of hand position on chest compression quality during CPR in young children: Findings from the Videography in Pediatric Resuscitation (VIPER) collaborative. Resuscitation. 2023 Apr;185:109741. doi: 10.1016/j.resuscitation.2023.109741. Epub 2023 Feb 16.

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