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J Pediatr. 2012 Oct;161(4):658-61. doi: 10.1016/j.jpeds.2012.03.019. Epub 2012 Apr 14.

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

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Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA.



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).


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.


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.


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.

[Indexed for MEDLINE]

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