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Two thumb compared with two finger cardiopulmonary resuscitation in infants
  1. Bruce Martin, Specialist Registrar,
  2. John Butler, Consultant
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK;


    A short cut review was carried out to establish whether the two thumb technique was superior to the two finger technique in delivering effective chest compressions in infants with cardiac arrest. Altogether 175 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

    • BETs
    • cardiopulmonary resuscitation
    • heart masage

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    Report by Bruce Martin,Specialist RegistrarChecked by John Butler, Consultant

    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 OR heart OR 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.

    Table 3


    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.


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

    Report by Bruce Martin,Specialist RegistrarChecked by John Butler, Consultant