The two-thumb is superior to the two-finger method for administering chest compressions in a manikin model of neonatal resuscitation

Background: Current neonatal guidelines endorse both the two-thumb and the two-finger techniques for performing chest compressions. It remains unclear whether one method is superior to the other in achieving consistent depth. Objective: To compare the compression depth, variability, rate and finger placement of the two-thumb and two-finger techniques using a compression to ventilation (CV) ratio of 3:1. Methods: 25 subjects (physicians and neonatal nurses) participated with compressions performed on a manikin. Subjects were video recorded. Evaluations included continuous compression administered for 60 s, followed by 2 min of compressions using a 3:1 CV ratio for each of the two techniques. Results: Depth during 60 s of uninterrupted compressions was greater for the two-thumb than the two-finger technique (27.2±5.7 vs 22.1±4.6 mm; p=0.0008), variability was less (6.7%±3.2% vs 9.0%±2.8%; p=0.002) and rate was comparable (118±22 vs 116±24 compressions/min). With a 3:1 CV ratio, depth was greater for the two-thumb compared to the two-finger method (29±5.4 vs 23.7±5.8 mm; p=0.0009), variability was less (6.1%±2.9% vs 9.8%±3.1%; p=0.00002) and rate was comparable (192±26 vs 197±31 compressions/2 min). Correct positioning was accomplished more often with the two-thumb than the two-finger technique (21/25 vs 3/25; p=0.0005). Conclusions: The two-thumb technique is superior to the two-finger technique, achieving greater depth and less variability with each compression. The two-finger technique was incorrectly applied in most cases and deviations in technique may have contributed to the significant differences in depth.