The two-thumb technique using an elevated surface is preferable for teaching infant cardiopulmonary resuscitation

Objectives: To determine whether the two-thumb technique is superior to the two-finger technique for administering chest compressions using the floor surface and the preferred location for performing infant cardiopulmonary resuscitation (CPR) (ie, floor, table, or radiant warmer). Study design: Twenty Neonatal Resuscitation Program trained medical personnel performed CPR on a neonatal manikin utilizing the two-thumb vs two-finger technique, a compression to ventilation ratio of 30:2 for 2 minutes in random order on the floor, table, and radiant warmer. Results: Compression depth favored the two-thumb over two-finger technique on the floor (27 ± 8 mm vs 23 ± 7), table (26 ± 7 mm vs 22 ± 7), and radiant warmer (29 ± 4 mm vs 23 ± 4) (all P <.05). Per individual subject, the compression depth varied widely using both techniques and at all surfaces. More variability between compressions was observed with the two-finger vs two-thumb technique on all surfaces (P <.05). Decay in compression over time occurred and was greater with the two-finger vs two-thumb technique on the floor (-5 ± 7 vs -1 ± 6 mm; P <.05) and radiant warmer (-3 ± 6 vs -0.3 ± 2 mm; P <.05), compared with the table (-3 ± 9 vs -4 ± 5 mm). Providers favored the table over radiant warmer, with the floor least preferred and most tiring. Conclusions: The two-thumb technique is superior to the two-finger technique, achieving greater depth, less variability, and less decay over time. The table was considered most comfortable and less tiring. The two-thumb technique should be the preferred method for teaching lay persons infant CPR preferably using an elevated firm surface.