Abstract 14604: Infant Chest Compression Quality: A Video-based Comparison of Two-thumb Versus One-hand Position in Emergency Department Patients
Introduction: Guidelines for infant chest compressions (CCs) recommend the 2-thumb encircling hand position, based on animal and mannequin data. No studies of CC quality based on hand position in actual infants currently exist.
Objective: To use video review to compare CC quality between 2-thumb encircling (2T) and one-hand anterior (1H) hand position in infants receiving CPR.
Methods: Observational study from Sep 2015 to Apr 2016. Resuscitations in a pediatric ED are videorecorded for quality improvement. Events where an infant received > 2 minutes of CC using a CPR monitor device while videorecorded were included. CC were measured in segments provided by a single compressor; segment duration, identity of the compressor, and hand position (2T vs 1H) was determined from video review. CC rate and depth were measured by the monitor device. Univariate analysis of CC rate and depth was done between 2T and 1H for all events; secondary analyses were done among 1) individual providers who performed CCs using 2T and 1H at some point during the study period, and 2) individual providers who used 2T and 1H on the same patient.
Results: Six infants received 95 minutes of CCs from a total of 23 providers during the study period. 12/23 providers were assessed using both 2T and 1H; during one event, 4 providers used 2T and 1H in the same patient. 72 CC segments were analyzed; the median duration of CC segments was 71 s (IQR 50 – 95 s). Median CC rate across all segments was 128/min (IQR 116 – 143 per min); median CC depth was 3.1 cm (IQR 2.7 – 3.5 cm). 2T position was used in 28/72 (39%) of segments. There was no significant difference in CC depth between 2T and 1H position (3.2 ± 0.6 vs 3.1 ± 0.5 cm, p=0.28). 1H position was significantly associated with faster CC rate than 2T position (137 ± 16 vs. 117 ± 15 CC/min, p<0.001); this difference remained significant when analyzing only providers who used both techniques (140 ± 15 vs. 117 ± 15 CC/min, p<0.001) or providers who used both techniques in the same patient (149 ± 11 vs. 130 ± 23 CC/min, p=0.03).
Conclusions: During CC in infants, 1H position was associated with a greater prevalence of inappropriately fast CC rate compared to 2T. There was no significant difference in depth between 2T and 1H. Future studies should evaluate the effect of hand position on clinical outcomes.
Author Disclosures: H. Jang: None. H. Wolfe: None. T. Hsieh: None. M. Abbadessa: None. S. Myers: None. V. Nadkarni: None. A. Donoghue: Research Grant; Modest; Zoll Foundation, NIH.
- © 2016 by American Heart Association, Inc.