Optimal chest compression technique for paediatric cardiac arrest victims

The aim of this study was to assess the quality of chest compressions performed by inexperienced rescuers using three different techniques: two-hand, right one-hand, and left one-hand.

We performed a prospective, randomised, crossover study in a simulated 6-year-old paediatric manikin model. Each participant performed 2-minute continuous chest compressions, using three different techniques. Chest compression quality data, including compression rate, compression depth, and residual leaning was recorded by a Q-CPR™ compression sensor connected to HeartStart MRx (Philips Healthcare, Andover, MA, USA). To examine trends in chest compression performance over time, each 2-minute period was divided into six consecutive 20-second epochs.

The 36 participants completed 108 two-minute trials, consisting of a total of 25,030 compressions. The mean compression rates [95% confidence interval] were as follows: two-hand, 116.8 [111.7–121.9]; left one-hand, 115.0 [109.9–120.1]; and right one-hand, 115.5 [110.4–120.6] (p = 0.565). The mean compression depth for two-hand was 38.7 mm (37.1–40.2), which was higher than for left one-hand (36.3 mm [34.8–37.9]) or right one-hand (35.4 mm [33.9-37.0]) (p < 0.001). Chest compression depth declined over time, regardless of the technique (p < 0.001). The pattern of compression depth change over time was similar for all techniques (p > 0.999). The residual leaning rate was higher with two-hand (40.7 [27.9–53.5]) than that for left one-hand (29.2 [16.4–42.0]) or right one-hand (25.8 [13.0–38.6]) (p = 0.021).

For paediatric cardiopulmonary resuscitation by inexperienced rescuers, the two-hand technique has the advantage of producing deeper compressions than the one-hand technique, but it is accompanied by more frequent residual leaning. For the one-hand techniques, the right and left hand produced chest compressions of similar quality.