Article Data

  • Views 2882
  • Dowloads 213

Original Research

Open Access Special Issue

Analysis of the adequacy of infant cardiopulmonary resuscitation according to chest compression technique based on the 2020 AHA guidelines

  • Hyun-Jung Kim1
  • Jin-Hwa Kim2
  • Dahye Park3,*,

1Department of Nursing, Daewon University College, 51524 Jecheon, Republic of Korea

2Department of Emergency Medical Technology, Daewon University College, 51524 Jecheon, Republic of Korea

3Department of Nursing, Semyung University, 27136 Jecheon, Republic of Korea

DOI: 10.22514/sv.2022.071 Vol.19,Issue 3,May 2023 pp.103-111

Submitted: 22 April 2022 Accepted: 01 June 2022

Published: 08 May 2023

*Corresponding Author(s): Dahye Park E-mail:


The quantitative and qualitative differences between the two-finger (TF) and two-thumb-encircling hands (TT) techniques were not sufficiently investigated to determine which is more effective for single-rescuer infant cardiopulmonary resuscitation (CPR). As the type of chest compression (CC) technique can impact survival rates and prognoses of patients, this study aimed to compare the adequacy of single-rescuer infant CPR CC techniques and explore participants’ CPR experiences using an exploratory sequential mixed methods design. To assess the adequacy of CC and ventilation according to technique, 70 students who completed basic life support provider certification among students from emergency medical services and nursing departments of a single college performed CC using the TF and TT techniques (4 sets of 5 cycles with a ratio of 30:2) in simulation. Meanwhile, a numeric rating scale was used to measure fatigue. SPSS (v. 25.0, IBM Corp, Armonk, NY, USA) was used to analyze the collected data by frequency analysis, descriptive statistics, paired t-test, and repeated measures analysis of variance (ANOVA). We conducted focus group interviews and analyzed CPR experiences. There were statistically significant differences between the TF and TT techniques in fatigue score (6.09 vs. 4.23 points, p < 0.001), average hands-off time (6.77 vs. 7.43 s, p =0.001), mean ventilation volume (41.40 vs. 35.51 ml, p = 0.002), CC accuracy rate (65.89% vs. 77.11%, p = 0.011), mean CC rate (104.37 vs. 107.11 beats/min, p = 0.020), overall CPR score (78.26 vs. 84.37 points, p = 0.005), and overall compression score (82.60 vs. 92.54 points, p < 0.001). Furthermore, we found significant differences over time in mean CC count (p = 0.030), mean ventilation volume (p = 0.042), and mean hands-off time (p = 0.029). Two categories (ambivalent attitudes and perception of pain) and five sub-categories were derived based on the results. In conclusion, as stated in the 2020 American Heart Association (AHA) guidelines, both TF and TT techniques are useful for single-rescuer infant CPR. Overall, TT technique provides higher quality of compressions at the cost of fewer ventilations. We recommend future studies of more diverse groups and techniques.


Infant; Chest compression; Two fingers; Two thumbs; Cardiopulmonary resuscitation

Cite and Share

Hyun-Jung Kim,Jin-Hwa Kim,Dahye Park. Analysis of the adequacy of infant cardiopulmonary resuscitation according to chest compression technique based on the 2020 AHA guidelines. Signa Vitae. 2023. 19(3);103-111.


[1] Jayaram N, McNally B, Tang F, Chan PS. Survival after out-of-hospital cardiac arrest in children. Journal of the American Heart Association. 2015; 4: e002122.

[2] Cioccari G, Sica da Rocha T, Piva JP. Two-thumb technique is superior to two-finger technique in cardiopulmonary resuscitation of simulated out-of-hospital cardiac arrest in infants. Journal of the American Heart Association. 2021; 10: e018050.

[3] Sutton RM, French B, Niles DE, Donoghue A, Topjian AA, Nishisaki A, et al. 2010 American heart association recommended compression depths during pediatric in-hospital resuscitations are associated with survival. Resuscitation. 2014; 85: 1179–1184.

[4] Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL, et al. Part 11: Pediatric basic life support and cardiopulmonary resuscitation quality: 2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015; 132: S519–S525.

[5] Korean Association of Cardiopulmonary Resuscitation. 2020 Korean Guidelines for Cardiopulmonary Resuscitation and Emergency Car-diovascular Care. 2022. Available at: 4 September 2021).

[6] Kim YJ, Lee KY. Comparing the efficiency and convenience of one-rescuer cardiopulmonary resuscitation chest compression techniques for infants. The Korean Journal of Emergency Medical Services. 2019; 23: 109–123.

[7] Two-thumb or two-finger technique in infant cardiopulmonary resuscitation by a single rescuer? A meta-analysis with GOSH analysis. International Journal of Environment Research and Public Health. 2020; 17: 5214.

[8] Lee SY, Hong JY, Oh JH, Son S. The superiority of the two-thumb over the two-finger technique for single-rescuer infant cardiopulmonary resuscitation. European Journal of Emergency Medicine. 2018; 25: 372–376.

[9] Udassi S, Haque IU, Lopez-Colon D, Shih A, Vasudeva D, Kaliki-Venkata G, et al. Chest compression by two-thumb encircling method generates higher carotid artery blood flow in swine infant model of cardiac arrest. Resuscitation Plus. 2021; 6: 100118.

[10] Udassi S, Udassi JP, Lamb MA, Theriaque DW, Shuster JJ, Zaritsky AL, et al. Two-thumb technique is superior to two-finger technique during lone rescuer infant manikin CPR. Resuscitation. 2010; 81: 712–717.

[11] Badaki-Makun O, Nadel F, Donoghue A, McBride M, Niles D, Seacrist T, et al. Chest compression quality over time in pediatric resuscitations. Pediatrics. 2013; 131: e797–e804.

[12] Elo S, Kyngäs H. The qualitative content analysis process. Journal of Advanced Nursing. 2008; 62: 107–115.

[13] National Fire Agency. Analysis of the status of 119 emergency services in 2017. Available at: (Accessed: 22 March 2021).

[14] Lee JE, Lee J, Oh J, Park CH, Kang H, Lim TH, et al. Comparison of two-thumb encircling and two-finger technique during infant cardiopulmonary resuscitation with single rescuer in simulation studies. Medicine. 2019; 98: e17853.

[15] Smereka J, Szarpak L, Smereka A, Leung S, Ruetzler K. Evaluation of new two-thumb chest compression technique for infant CPR performed by novice physicians. A randomized, crossover, manikin trial. The American Journal of Emergency Medicine. 2017; 35: 604–609.

[16] Tham LP, Wah W, Phillips R, Shahidah N, Ng YY, Shin SD, et al. Epidemiology and outcome of paediatric out-of-hospital cardiac arrests: a paediatric sub-study of the pan-Asian resuscitation outcomes study (PAROS). Resuscitation. 2018; 125: 111–117.

[17] Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, et al, Paediatric life support section Collaborators. European resuscitation council guidelines for resuscitation 2015: section 6. Paediatric life support. Resuscitation. 2015; 95: 223–248.

[18] Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Nadkarni VM, et al. Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. The Lancet. 2010; 375: 1347–1354.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.3 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time