Evaluation of new two-thumb chest compression technique for infant CPR performed by novice physicians. A randomized, crossover, manikin trial

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The impact of high-quality chest compressions during CPR for the patients' outcome is undisputed, as it is essential for maintaining vital organ perfusion. The aim of our study is to compare the quality of chest compression (CC) and ventilation among the two current standard techniques with our novel “nTTT” technique in infant CPR.


In this randomized crossover, manikin trial, participants performed CCs using three techniques in a randomized sequence: standard two finger technique (TFT); standard two thumb technique (TTHT), and the ‘new two-thumb technique’ (nTTT). The novel method of CCs in an infant consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist.


Median depth compression using the distinct chest compression techniques varied and amounted to 26 [IQR, 25–28] mm for TFT, and 39 [IQR, 39–39] mm for TTHT as well as for nTTT. Best percentage of fully released compressions were received using TFT (100[100 − 100] %), then in the case of nTTT (99[98–100] %), and the worst in situation where TTHT (18[14–19] %). was used. The fastest chest compression rate was achieved with TFT (134[IQR, 129–135]/min) and the slowest when using nTTT (109 [IQR, 105–111]/min).


We found that our new nTTT technique's performance, in terms of compression depth, hands-off time, and ventilation quality, is comparable to the current standards. Based on our findings of this initial manikin study, the nTTT technique is superior to TFT in many of parameters that are vital to a quality chest compression during pediatric CPR.

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