Clinical paperOne-handed versus two-handed chest compressions in paediatric cardio-pulmonary resuscitation☆
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.
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2022, American Journal of Emergency MedicineCitation Excerpt :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.
Part 10: Paediatric basic and advanced life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
2010, ResuscitationCitation Excerpt :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.
Effect of alternative chest compression techniques in infant and child on rescuer performance
2009, Pediatric Critical Care MedicineImproving pediatric cardiopulmonary resuscitation techniques on manikins: One small step for critical care medicine⋯ one giant leap for mankind!
2009, Pediatric Critical Care Medicine
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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