Background: The American Heart Association (AHA) recommends the 2-finger technique (TFT) for a lone rescuer and the 2-thumb encircling hands technique (TTHT) for two rescuers during infant cardiopulmonary resuscitation (CPR). High quality chest compression is the most important factor in survival and neurologic outcome. However, chest compressions during pediatric CPR are often suboptimal. 
Objective: To compare the TFT, three-finger technique (Pinch technique) and the plate-assisted technique (PAT) of chest compression on an infant manikin model.
Methods: A prospective, randomized crossover manikin trial at a tertiary teaching hospital. The participants involved were 50 medical doctors and medical school students who had no previous training in infant CPR. In a randomized sequence, the TFT, the Pinch technique and PAT of chest compression were performed on an infant manikin. The participants performed each technique for 2 minutes and rested for 2 minutes. The compression depth (CD), rate, recoil, and correct hand position were recorded. At the end of the study, each participant completed the Likert scale-based questionnaire. The questionnaire checked the fatigue, satisfaction and difficulty in using each method of rescuers.
Results: The mean CD of the TFT, Pinch technique and PAT was 3.16 mm, 3.61mm and 4.01mm, respectively (P<0.001; target ≥4 mm). In all the techniques, chest compression rates achieved a target of 100-120/min.  The TFT method was able to obtain complete chest recoil with the highest frequency, followed by the pinch technique and then PAT (89.9%, 85.2%, 74.7%, respectively. p=0.002). The highest correct hand position percentage was recorded from the PAT, followed by the Pinch, and the lowest was the TFT (95.4%, 81.6%, 77.8% respectively. P<0.001). Use of the new device technique by participants resulted in high satisfaction, less fatigue, and less difficulty.

Conclusions: The new device technique of chest compression was superior to the other techniques in many parameters. However, the percentage of complete chest recoil  was lower than other techniques.

Method of chest compression for infants in a single rescuer; evaluation of chest compression technique and new device