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Biomechanical analysis of force distribution in one-handed and two-handed adult chest compression: a randomised crossover observational study
  1. Chia-Lung Kao1,
  2. Jui-Yi Tsou2,
  3. Ming-Yuan Hong1,
  4. Chih-Jan Chang1,
  5. Chih-Hsien Chi1
  1. 1 Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  2. 2 Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
  1. Correspondence to Dr Chih-Hsien Chi, Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan 701, Taiwan; chich{at}


Introduction The standard method of chest compression for adults is a two-handed procedure. One-handed external chest compression (ECC) is used in some situations such as during transport of patients who had an out-of-hospital cardiac arrest, but the quality of one-handed ECC is still not well known. The distribution of force is related to the quality of chest compression and may affect the risk of injury. This study aimed to determine the differences in the quality and potential safety concern between one-handed ECC and two- handed ECC.

Methods In this randomised crossover study, participants recruited from National Cheng Kung University Hospital and the ambulance team from the fire bureau were asked to perform one-handed and two-handed ECC on the Resusci Anne manikin according to standard 2015 ECC guidelines. The MatScan Pressure Measurement system was used to investigate the compression pressure and force distribution.

Results Two-handed ECC had better results than one-handed ECC in terms of the median (IQR) depth (51.00 (41.50–54.75) mm vs 42.00 (27.00–49.00) mm, p=0.018), the proportion of depth accuracy (82.05% (13.95%–99.86%) vs 11.17% (0.00%–42.13%), p=0.028) and the proportion of incomplete recoil (0.23% (0.01%–0.44%) vs 2.42% (0.60%–4.21%), p=0.002). The maximum force (45.72 (36.10–80.84) kgf vs 35.64 (24.13–74.34) kgf, p<0.001) and ulnar–radial force difference (7.13 (−16.58 to 21.07) kgf vs 23.93 (11.19–38.74) kgf, p<0.001) showed statistically significant differences. The perceived fatigue of two-handed ECC versus one-handed ECC was 5.00 (3.00–6.00) vs 6.00 (5.00–8.00), p<0.001.

Conclusion The quality of one-handed ECC, based on depth and recoil, is worse than that of standard two-handed ECC. The pressure and force distribution of one-handed ECC result in greater ulnar pronation of the hand than that of two-handed ECC. One-handed ECC more easily causes operator fatigue. Acknowledging these findings and adjusting training for one-handed ECC would potentially improve the quality of cardiopulmonary resuscitation during transport.

  • resuscitation
  • training
  • research

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Handling editor David Metcalfe

  • Contributors C-LK—methodology, investigation, data curation, writing original draft, review and editing, and funding acquisition. J-YT—data curation, formal analysis, and writing, review and editing. M-YH and C-JC—writing, review and editing. C-HC—conceptualisation, methodology, supervision, and writing original draft, review, editing and funding acquisition.

  • Funding This study was partly supported by the National Cheng Kung University Hospital Research Project (NCKUH-10508024) and Ministry of Science and Technology of Taiwan (No. 99-2320-B-006-003-MY2).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.