Role of dominant versus non-dominant hand position during uninterrupted chest compression CPR by novice rescuers: A randomized double-blind crossover study

doi:10.1016/j.resuscitation.2007.07.032

Resuscitation

Volume 76, Issue 2, February 2008, Pages 256-260

https://doi.org/10.1016/j.resuscitation.2007.07.032 Get rights and content

Summary

Background

Previous research has suggested improved quality of chest compressions when the dominant hand was in contact with the sternum. However, the study was in health care professionals and during conventional chest compression-ventilation CPR. The aim of this study was to test the hypothesis, in null form, that the quality of external chest compressions (ECC) in novice rescuers during 5 min of uninterrupted chest compression CPR (UCC-CPR) is independent of the hand in contact with the sternum. Confirmation of the hypothesis would allow the use of either hand by the novice rescuers during UCC-CPR.

Methods

Fifty-nine first year public heath students participated in this randomised double-blind crossover study. After completion of a standard adult BLS course, they performed single rescuer adult UCC-CPR for 5 min on a recording Resusci Anne^®. One week later they changed the hand of contact with the sternum while performing ECC. The quality of ECC was recorded by the skill meter for the dominant and non-dominant hand during 5 min ECC.

Results

The total number of correct chest compressions in the dominant hand group (DH), mean 183 ± 152, was not statistically different from the non-dominant hand group (NH), mean 152 ± 135 (P = 0.09). The number of ECC with inadequate depth in the DH group, mean 197 ± 174 and NH group, mean 196 ± 173 were comparable (P = 0.1). The incidence of ECC exceeding the recommended depth in the DH group, mean 51 ± 110 and NH group, mean 32 ± 75 were comparable (P = 0.1).

Conclusions

Although there is a trend to increased incidence of correct chest compressions with positioning the dominant hand in contact with the sternum, it does not reach statistical significance during UCC-CPR by the novice rescuers for 5 min.

Introduction

Chest compression has been one of the principal elements of circulatory support during cardiopulmonary resuscitation (CPR) for more than 40 years.¹ To date, the early performance of adequate chest compressions is a standard of care that is considered to provide the optimal outcome in cardiopulmonary arrest.²

They are especially important if the first shock is delivered more than 5 min after collapse.3, 4 Several components of chest compressions can alter its effectiveness: hand position, position of the rescuer, position of the victim, depth and rate of compression, decompression, and duty cycle.⁵ A manikin study in healthcare professionals showed improved quality of chest compressions when the dominant hand was in contact with the sternum.⁶ According to this study, ILCOR 2005 guidelines recommend that is reasonable for laypeople and healthcare professionals to be taught to position the heel of their dominant hand in the centre of the chest of an adult victim, with the non-dominant hand on top.⁷ These guidelines also recommend that rescuers should be encouraged to do UCC-CPR if they are unwilling to do airway and breathing manoeuvers or if they are not trained in CPR or are uncertain how to do CPR.⁷

Considering the fact that rescuer fatigue may affect the quality of ECC,8, 9, 10 this study was designed to evaluate whether the position of the rescuer's dominant hand in relation to the non-dominant hand has any influence on the quality of UCC-CPR for 5 min by first year public health students. We also evaluated the gender differences in the continuous chest compression CPR.

Section snippets

Materials and method

This randomized double-blind crossover study was conducted in 2006 at Fasa University of Medical Sciences in Iran. The study was approved by the faculty review board. First year public heath students were recruited to participate in a study involving an ‘experimental’ resuscitation technique in conjunction with their elective CPR training module. No incentive was offered initially for the participation in the study, however, once enrolled; students were offered $20 as an incentive to be

Results

Of a class of 120 public heath students attended the course, 70 agreed to participate and provided informed consent before their participation in the project. Three of them did not participate. Of the 67 students involved in the initial testing, 60 returned to retest. One of the students was excluded in the second session of the evaluation because of her wrist pain. Fifty-nine students completed both the dominant hand-CPR and the non-dominant hand-CPR branches of the study. Median age of the

Discussion

This double-blind crossover study shows that although positioning the dominant hand in contact with the sternum may increase the total number of the correct ECC during the 5 min of UCC-CPR by novice rescuers, it does not reach statistical significance. The same finding is seen when the data of either sex are considered separately for the effect of dominant or non-dominant hand on the quality of ECC. This is in contrast to the findings of Kundra et al., who showed that the dominant hand placement

Conclusion

In summary, although there is a trend towards an increased incidence of correct chest compressions with positioning the dominant hand in contact with the sternum, it does not reach statistical significance during UCC-CPR by the novice rescuers for 5 min. Until further studies prove otherwise we would recommend using either dominant or non-dominant hand in contact with the sternum during UCC-CPR by lay rescuers.

Conflict of interest

None of the authors has a conflict of interest related to this study.

Acknowledgments

We thank the public heath students involved in the study for enthusiastic participation. We are indebted to Abol Ghasem Avand for a critical review of the manuscript.

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

Cited by (23)

How does the side of approach impact the force delivered during external chest compression?
2021, American Journal of Emergency Medicine
We investigated the biomechanics of four external chest compression (ECC) approaches involving different sides of approach and hand placement during cardiopulmonary resuscitation (CPR).
A total of 60 participants (30 women and 30 men) with CPR certification performed standard continuous 2-min ECC on a Resusci Anne manikin with real-time feedback in four scenarios: rescuer at the manikin's right side with right hand chest contact (RsRc), rescuer at the manikin's right side with left hand chest contact (RsLc), rescuer at the manikin's left side with left hand chest contact (LsLc), and rescuer at the manikin's left side with right hand chest contact (LsRc). Pressure distribution maps of the palm, peak compression pressure, and compression forces were analysed.
The participants' mean age, height, and weight was 24.8 ± 4.8 years, 165.8 ± 8.7 cm, and 62.7 ± 13.5 kg, respectively. Of the participants, 58 and 2 were right- and left-handed, respectively. Significant between-scenario differences were observed in ulnar-side palm pressure. Ulnar–radial pressure differences were higher in the LsLc and RsRc groups than in the LsRc and RsLc groups (0.69 ± 0.62 and 0.73 ± 050 kg/cm² vs. 0.49 ± 0.49 and 0.50 ± 0.59 kg/cm²; respectively; p < 0.05). Ulnar–radial force differences were higher in the LsLc and RsRs groups than in the sLsLc and RsRs groups.
The higher differences in pressure and force under the LsLc and RsRc approaches may lead to higher risks of potential injury. When performing standard-quality ECC, the LsRc and RsLc approaches, in which compression pressure and force are better distributed, may be more suitable than RsRc or LsLc.
Dominant versus non-dominant hand during simulated infant CPR using the two-finger technique: a randomised study
2021, Resuscitation Plus
Citation Excerpt :
Similarly, Kim et al. (2015)19 compared one-hand technique in paediatric CPR for CCR, CCD and peak compression pressure and found no significant differences. In the adult population, Nikandish et al. (2008)17 investigated the quality of adult chest compressions in relation to the hand in contact with the sternum delivered by first year healthcare students and concluded that it was not significantly different. However, the results from our experiment and the studies cited above contrast with the findings from Kim et al. (2016),12 who compared infant chest compressions using index-middle vs. middle-ring fingers for the right vs. the left hand and concluded that the most effective performance for the TFT was obtained using the index-middle fingers of the right hand.
The aim of this randomised study was to compare the two-finger technique (TFT) performance using dominant hand (DH) and non-dominant hand (NH) during simulated infant CPR (iCPR).
24 participants performed 3-min iCPR using TFT with DH or NH followed by 3-min iCPR with their other hand. Perceived fatigue was rated using visual analogue scale. Primary outcomes - (i) difference between DH and NH for compression depth (CCD), compression rate (CCR), residual leaning (RL) and duty cycle (DC); (ii) difference between first and last 30 s of iCPR performance with DH and NH. Secondary outcomes - (i) perception of fatigue between DH and NH; (ii) relationship between perception of fatigue and iCPR performance.
No significant difference between DH and NH for any iCPR metric. CCR (DH: P = 0.02; NH: P = 0.004) and DC (DH: P = 0.04; NH: P < 0.001) were significantly different for the last 30 s for DH and NH. Perception of fatigue for NH (76.8 ± 13.4 mm) was significantly higher (t = −3.7, P < 0.001) compared to DH (62.8 ± 12.5 mm). No significant correlation between iCPR metrics and perception of fatigue for DH. However, a significant correlation was found for CCR (r = 0.43; P = 0.04) and RL (r = −0.48; P = 0.02) for NH.
No difference in performance of iCPR with DH versus NH was determined. However, perception of fatigue is higher in NH and was related to CCR and RL, with no effect on quality of performance. Based on our results, individuals performing iCPR can offer similar quality of infant chest compressions regardless of the hand used or the perception of fatigue, under the conditions explored in this study.
CPR training related injuries. Even if injured hands are excellent life-saving devices
2016, Resuscitation
Compressing with dominant hand improves quality of manual chest compressions for rescuers who performed suboptimal CPR in manikins
2015, American Journal of Emergency Medicine
Citation Excerpt :
An alternative approach for improving rescuer performance was to place the dominant hand against the chest during compressions [20]. However, Nikandish et al [21] reported that the quality of chest compressions was independent of the hand in contact with the sternum during 5 minutes of compression-only CPR performed according to earlier guidelines. Considering the fact that there was a huge interindividual distribution of physical fitness and CPR performance quality among rescuers [22], we sought to investigate the influence of dominant vs nondominant hand positioning on the performance of CPR in rescuers who performed optimal and suboptimal compressions.
The question of whether the placement of the dominant hand against the sternum could improve the quality of manual chest compressions remains controversial. In the present study, we evaluated the influence of dominant vs nondominant hand positioning on the quality of conventional cardiopulmonary resuscitation (CPR) during prolonged basic life support (BLS) by rescuers who performed optimal and suboptimal compressions.
Six months after completing a standard BLS training course, 101 medical students were instructed to perform adult single-rescuer BLS for 8 minutes on a manikin with a randomized hand position. Twenty-four hours later, the students placed the opposite hand in contact with the sternum while performing CPR. Those with an average compression depth of less than 50 mm were considered suboptimal.
Participants who had performed suboptimal compressions were significantly shorter (170.2 ± 6.8 vs 174.0 ± 5.6 cm, P = .008) and lighter (58.9 ± 7.6 vs 66.9 ± 9.6 kg, P < .001) than those who performed optimal compressions. No significant differences in CPR quality were observed between dominant and nondominant hand placements for these who had an average compression depth of greater than 50 mm. However, both the compression depth (49.7 ± 4.2 vs 46.5 ± 4.1 mm, P = .003) and proportion of chest compressions with an appropriate depth (47.6% ± 27.8% vs 28.0% ± 23.4%, P = .006) were remarkably higher when compressing the chest with the dominant hand against the sternum for those who performed suboptimal CPR.
Chest compression quality significantly improved when the dominant hand was placed against the sternum for those who performed suboptimal compressions during conventional CPR.
Dominant hand position improves the quality of external chest compression: A manikin study based on 2010 CPR guidelines
2015, Journal of Emergency Medicine
Citation Excerpt :
Our study was not designed to interfere with the choices of the participants. Thus, we did not ask the participants to perform CPR twice using each hand as the compression hand, as was done in the studies by Kundra et al. and Nikandish et al. (4,5). Therefore, we believe that we observed instinctual CPR performances, which may help us to identify the primary differences between the use of the dominant and nondominant hands.
The 2010 cardiopulmonary resuscitation (CPR) guidelines increased the importance of external chest compression. However, the best hand position to be the compressing one has not been identified.
To investigate the effects of dominant or nondominant external chest compression hand position during CPR.
Medical students performed five cycles of conventional CPR and completed one questionnaire. The CPR performances were manually evaluated, and detailed aspects of the external chest compression quality were assessed via the SimMan® Essential system (Laerdal China Ltd., Hangzhou, China).
One hundred fifty-seven students participated in the nondominant hand (NH) group, and 68 students participated in the dominant hand (DH) group. The manual evaluations revealed no differences between the two groups. The proportion of chest compressions “above 100 cpm [compressions per minute]” was higher in the DH group than in the NH group (97% vs. 92%, respectively, p = 0.002). The frequency distributions of the chest compression rates were also significantly different between the two groups (p < 0.0001). The distribution of the NH group was concentrated within “130–139” cpm, whereas this distribution was concentrated within “140–149” cpm in the DH group. The chest compression depth of the DH group was deeper than that of the NH group (p = 0.001). The depth of the fifth cycle was significantly decreased compared with those of cycles 1, 2, and 3 in the NH group. A greater number of full chest recoils were observed in the NH group (p = 0.02).
The dominant hand position during CPR was associated with a higher chest compression rate, a greater chest compression depth, and delayed fatigue.
Effect of a rescuer's side of approach on their performance of conventional cardiopulmonary resuscitation
2012, Resuscitation

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^☆: A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2007.07.032.

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Manikin and simulation studyRole of dominant versus non-dominant hand position during uninterrupted chest compression CPR by novice rescuers: A randomized double-blind crossover study☆

Summary

Background

Methods

Results

Conclusions

Introduction

Section snippets

Materials and method

Results

Discussion

Conclusion

Conflict of interest

Acknowledgments

Br J Anaesth

Ann Emerg Med

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Closed chest cardiac massage

J Am Med Assoc

Manikin and simulation study
Role of dominant versus non-dominant hand position during uninterrupted chest compression CPR by novice rescuers: A randomized double-blind crossover study☆