Elsevier

Resuscitation

Volume 71, Issue 1, October 2006, Pages 65-69
Resuscitation

Clinical paper
One-handed versus two-handed chest compressions in paediatric cardio-pulmonary resuscitation

https://doi.org/10.1016/j.resuscitation.2006.02.007Get rights and content

Summary

Objectives

To determine emergency department (ED) staff preference for one- or two-handed paediatric chest compressions and to determine if there was a difference in compression rates delivered and fatigability between the techniques.

Methods

This was a randomised, cross-over observational study of paediatric CPR performed on a standard paediatric manikin by ED staff. Consenting, eligible staff [ED doctors and nurses] performed CPR in pairs with chest compressions delivered using a one- and two-handed technique. The outcomes of interest were compression rates for one- and two-handed CPR, decrease in compression rate over time for each technique and staff preference for technique. Data was analysed using descriptive statistics, Chi Square test and Mann–Whitney U-test as appropriate.

Results

Sixty-two ED staff participated in the study. Compression rates with both techniques were similar and higher than guidelines recommend (133.6 min−1 for one-handed and 135.7 min−1 for two-handed respectively). The compression rate slowed by 6.9 compressions/min over 1 min in one-handed compressions compared with 2.6 compressions/min in two-handed compressions (p = 0.0264). 65.6% of participants reported that they preferred the two-handed compression technique.

Conclusion

This study showed that CPR compression rate is similar with one- and two-handed compression techniques, but compression rate decreased more quickly with the one-handed technique. The majority of staff preferred the two-handed compression technique for reasons of ease, control and uniformity with other CPR techniques.

Introduction

It is currently recommended that chest compressions be provided with the heel of one hand in paediatric CPR [children aged 1–8 years].1, 2, 3 This recommendation was arrived at by consensus and seems to be based on the assumptions that less force is required to compress the paediatric thorax and that there would be less risk of excessive force, and thus injury, with this technique.

It has recently been shown that two-handed compressions produce higher mean and peak compression pressures when compared to one-handed compressions and that 29/30 participants found the two-handed technique easier to perform.4

The aims of this study were to determine emergency department [ED] nursing and medical staff preference for one- or two-handed paediatric chest compressions; and to determine if there was a difference in compression rates delivered and fatigability between the techniques.

Section snippets

Materials and methods

This was a randomised crossover observational study conducted over two non-consecutive months in the period 8/11/2004–9/12/2004 and 15/2/2005–11/3/2005. It was undertaken in the ED of Western Hospital, Footscray, a tertiary care teaching hospital with an annual ED census of 34,000 patients. At the time of the study the ED employed 33 doctors and 68 nurses. The study was approved by the Institutional Ethics Committee.

The participants were medical and nursing staff of the Western Hospital ED, who

Results

Sixty-two ED staff took part in this study. Eighteen (41%) participants were male and the median age was 27 years (range 21–57). More nurses (66.1%) participated in the study than doctors (33.9%). The overall participation rate was 62/101 (61.4%). Most (89.5%) participants had completed an annual CPR assessment within 12 months of participating in this project.

The compression variables of one- and two-handed paediatric CPR observed in our study are presented in Table 1. Compression rates with

Discussion

This study showed that CPR compression rates are similar with one- and two-handed compression techniques, but compression rate fell more quickly with the one-handed technique. The majority of staff preferred the two-handed compression technique for reasons of ease, control and uniformity with other CPR techniques.

Current paediatric BLS guidelines 1, 2, 3 advocate that chest compressions be delivered with the “heel of one hand” for children aged 1–8 years. Compression rate should be 100 min−1 and

Conclusion

This study showed that CPR compression rate is similar with one- and two-handed compression techniques for paediatric resuscitation, but decreased more quickly with the one-handed technique. The majority of staff preferred the two-handed compression technique for reasons of ease, control and uniformity with other CPR techniques.

Conflicts of interest

The authors have no conflicts of interest to declare.

Acknowledgement

The authors would like to acknowledge the support of the staff of Western Hospital ED who participated in this study.

References (11)

There are more references available in the full text version of this article.

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    Although there are no pediatric-specific clinical data to determine if OHCC or THCC produces better outcomes for children receiving CPR, it is recommended that a specific technique considers the size of the thorax in children and the hand span in rescuers [1,10]. Previous studies confirmed that THCC was associated with improved CCD, increased compression force, and less rescuer fatigue [11-13]. These advantages of THCC advocate its use during CPR in children.

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    Evidence from one LOE 5 randomised crossover child manikin study196 showed that higher chest-compression pressures are generated by healthcare professionals using the two-hand technique. Two LOE 5 studies197,198 report no increase in rescuer fatigue comparing one-hand with two-hand chest compressions delivered by healthcare providers to a child-sized manikin. Either a one- or two-hand technique can be used for performing chest compressions in children.

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A Spanish translated version of the summary of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2006.02.007

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