The two thumb-encircling hands technique is an effective method for delivering chest compressions during infant cardiopulmonary resuscitation (CPR). This technique is employed in emergency situations to circulate blood and oxygen when an infant’s heart has stopped or is not beating effectively. It is a highly regarded approach in pediatric life support, particularly when multiple trained individuals are present.
Indications for Two Thumb-Encircling Hands Technique
This technique is indicated for infants experiencing cardiac arrest, especially when two or more trained rescuers are available. Infant cardiac arrest is often characterized by unresponsiveness, an absence of normal breathing (which may appear as no breathing at all or only gasping), and the lack of a palpable pulse or clear signs of circulation. A pulse rate below 60 beats per minute accompanied by signs of poor perfusion, such as pale or bluish discoloration, also warrants immediate intervention with chest compressions.
In a two-rescuer setting, this method is preferred over the single-rescuer two-finger technique because it generally allows for more consistent chest compressions and results in superior blood flow and blood pressure. The presence of a second rescuer enables one to focus on high-quality compressions while the other manages ventilations, optimizing the overall CPR effort. This coordinated approach ensures that both compressions and breaths are delivered efficiently, improving outcomes in infant cardiac arrest.
Scenarios Requiring Different Approaches
While the two thumb-encircling hands technique is effective for two-rescuer infant CPR, other situations necessitate different approaches. If only one rescuer is present, the two-finger technique is used for chest compressions. This involves placing two fingers on the center of the infant’s chest, just below the nipple line, and performing compressions at a ratio of 30 compressions to 2 breaths. The two-finger method allows a single rescuer to manage both compressions and ventilations.
Scenarios involving an infant who is choking require specific first aid measures. Signs of choking include coughing, gagging, or difficulty breathing. In such cases, the recommended intervention involves five back blows followed by five chest thrusts to dislodge the obstruction. If an infant has a pulse but is not breathing adequately, the focus shifts to providing rescue breaths without chest compressions, aiming to provide one breath every two to three seconds. These targeted interventions address the underlying respiratory problem, not primarily cardiac, and chest compressions are not appropriate if a pulse is present.
Important Considerations During Use
Proper execution is paramount for effectiveness. Position thumbs side-by-side on the center of the infant’s chest, just below the nipple line. The remaining fingers of both hands should encircle the infant’s chest, providing support to the back. This hand placement ensures compressions are delivered to the lower half of the breastbone.
Compressions should be performed to a depth of approximately one-third the depth of the infant’s chest, about 1.5 inches (4 centimeters). The rate of compressions should be maintained between 100 and 120 compressions per minute. Allow the chest to fully recoil after each compression, enabling the heart to refill with blood. In a two-rescuer situation, the compression-to-ventilation ratio is 15 compressions to 2 breaths, and rescuers should switch roles every two minutes to prevent fatigue and maintain quality compressions.
Immediate Actions After Application
After initiating CPR, several immediate actions are necessary. If emergency medical services (EMS) have not been activated, call for help promptly. If another person is present, direct them to call 911 while CPR continues.
CPR should be continued without interruption until EMS personnel arrive, the infant shows signs of life (such as normal breathing or movement). Throughout this period, the infant’s condition should be closely monitored for any changes. Even if the infant appears to recover and shows signs of life, it is imperative to seek professional medical evaluation. Underlying issues may need to be addressed, and comprehensive post-cardiac arrest care is important for the infant’s recovery.