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☆
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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Cited by (23)
How does the side of approach impact the force delivered during external chest compression?
2021, American Journal of Emergency MedicineDominant versus non-dominant hand during simulated infant CPR using the two-finger technique: a randomised study
2021, Resuscitation PlusCitation 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.
Compressing with dominant hand improves quality of manual chest compressions for rescuers who performed suboptimal CPR in manikins
2015, American Journal of Emergency MedicineCitation 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.
Dominant hand position improves the quality of external chest compression: A manikin study based on 2010 CPR guidelines
2015, Journal of Emergency MedicineCitation 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.
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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.