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The two-thumb is superior to the two-finger method for administering chest compressions in a manikin model of neonatal resuscitation
  1. Catherine Christman1,
  2. Rae Jean Hemway2,
  3. Myra H Wyckoff3,
  4. Jeffrey M Perlman1
  1. 1Department of Pediatrics, Weill Cornell Medical College, New York, USA
  2. 2Department of Nursing, New York Presbyterian Hospital, New York, USA
  3. 3Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA
  1. Correspondence to Professor Jeffrey M Perlman, Department of Pediatrics, Weill Cornell Medical College, 525 E 68th Street, N506, New York, NY 10065, USA; jmp2007{at}


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.

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  • Funding This study was funded by a grant from the American Academy of Pediatrics, Elk Grove, Illinois, USA.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board of Weill Cornell Medical College.

  • Provenance and peer review Not commissioned; externally peer reviewed.