Clinical scenario

You are put on standby by the paramedic emergency service for a cardiac arrest in an 8 week old baby. While you are assembling your equipment in the emergency department, you recall that APLS suggests a two thumb, hand encircling technique may be better when more than one rescuer is present, but rarely do you see this being used. You wonder whether current evidence supports this or not.

Three part question

In [infants in cardiac arrest] is [two thumb CPR better than two finger CPR] at [delivering effective chest compressions]?

Search strategy

Medline 1966-07/04 using the OVID interface.[{(exp Cardiopulmonary Resuscitation OR exp Heart Arrest/ OR cardiopulmonary resuscitation.mp OR heart arrest.mp OR CPR.mp) AND (chest compression$.mp OR exp Heart Massage)}OR cardiac compression$.mp] AND (BestBETs paediatric search filter) LIMIT to English language.

Search outcome

Altogether 175 papers found of which four helped to answer the question posed. These are summarised in table 3.

Comment(s)

In addition to these papers, the International Consensus on Science published revised guidelines in 2000, which, among other things advocated the use of two thumb technique where possible. Whether this leads to improvement in overall survival rates needs further evaluation.

CLINICAL BOTTOM LINE

Two thumb compression CPR produces improved haemodynamic states in experimental models, and should be performed when possible in preference to the two finger technique.