• Jeffrey L Pellegrino, David Bogumil, Jonathan L Epstein, and Rita V Burke.
• Health Sciences, Aultman College of Nursing and Health Sciences, Canton, Ohio, USA.
• Arch. Dis. Child. 2019 Jun 1; 104 (6): 530-534.

ObjectivePaediatric health providers and educators influence infant mortality through advocacy and training within families and communities. This research sought to establish the efficacy and training of two-finger versus two-thumb-encircling techniques for lone responder infant chest compressions with ventilations in initially trained infant caregivers.DesignThis is a randomised, cross-over educational intervention assessed on instrumented manikins using the 2015 guideline measures of quality infant cardiopulmonary resuscitation (CPR). Additional subjective data on the experience were collected through self-reporting.SettingNon-healthcare community organisations and secondary school classrooms.ParticipantsFourteen years or older, fluent in English and had not taken infant CPR in the last 5 years.InterventionsGroups of eight participants were randomised to learn one technique, practised and then tested for 8 min. After a 30 min rest, the group repeated the process using the other technique.Main Outcome MeasuresMean chest compression depth and rate, compression fraction, and correct hand position; tiredness and pain as reported by the caregiver.ResultsThe two-thumb-encircling technique achieved a deeper mean compression depth over the 8 min period (2.0 mm, p<0.01), closer to the minimum recommendation of 40 mm; the two-finger technique achieved higher percentages of compression fraction and complete recoil. Caregivers preferred the two-thumb technique (64%), and of these 70% had long fingernails.ConclusionsThe two-thumb-encircling technique improved compression depth, over an 8 min scenario, and was preferred by caregivers. This adds to the existing literature on the advantages of two-thumb-encircling as a technique for lone and team infant CPR, which counters current guidelines.© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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