A comparison of the area of chest compression by the superimposed-thumb and the alongside-thumb techniques for infant cardiopulmonary resuscitation.

Abstract

We investigated whether the superimposed-thumb technique could reduce the chest compression area in infant cardiopulmonary resuscitation (CPR). Charts and multidirectional computed tomography images of infants presented to four hospitals from January 2007 to September 2010 were reviewed retrospectively. We measured at the point of maximal anterior-posterior heart diameter the width of the sternum meter (S(ap)), vertical heart length from S(ap), length and width of the superimposed-thumb technique and length and width of the alongside-thumb technique. We studied the structures located underneath thumbs superimposed and thumbs alongside at S(ap) and S(nipple) (the sternum of the inter-nipple line). In the 84 infants enrolled, the width of the sternum at S(ap), and the vertical heart length from S(ap) were 0.85 ± 0.31 and 1.71 ± 0.47 cm, respectively. The length and width of the superimposed-thumb technique were 1.65 ± 0.13 and 2.73 ± 0.22 cm, respectively. The length and width of the alongside-thumb technique were 3.00 ± 0.48 and 3.77 ± 0.24 cm, respectively. The liver was situated underneath thumbs superimposed at S(ap) in 59.5% infants. The livers and lungs of 73.8% and 64.3% infants, respectively, were underneath thumbs alongside at S(nipple). In this study, we confirmed that the superimposed-thumb technique may reduce chest compression area in infant CPR. The lungs or livers were located more often underneath thumbs alongside at S(nipple) than underneath thumbs superimposed at S(ap). However, further studies are needed to validate the efficiency and safety of this technique.