Letter to the Editor
The thumbs angle used in the novel infant chest compression technique (new two-thumb technique, nTTT) can influence the quality parameters of resuscitation
El ángulo de pulgares que usa una nueva técnica de masaje cardíaco en lactantes (nTTT) puede influir en los parámetros de calidad de la reanimación
a Lazarski University, Warsaw, Poland
b Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
c Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
d Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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Szarpak, J. Smereka, J.R. Ladny, K. Ruetzler" "autores" => array:4 [ 0 => array:3 [ "nombre" => "L." "apellidos" => "Szarpak" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "J." "apellidos" => "Smereka" "email" => array:1 [ 0 => "jacek.smereka@umed.wroc.pl" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "J.R." "apellidos" => "Ladny" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "K." "apellidos" => "Ruetzler" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Lazarski University, Warsaw, Poland" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El ángulo de pulgares que usa una nueva técnica de masaje cardíaco en lactantes (nTTT) puede influir en los parámetros de calidad de la reanimación" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">we read with great interest the article published by Dr. Rodriguez-Ruiz et al. <span class="elsevierStyleItalic">Nueva técnica de masaje cardíaco en lactantes</span> (<span class="elsevierStyleItalic">A new chest compression technique in infants</span>), published in <span class="elsevierStyleItalic">Medicina Intensiva</span>.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The data presented in the paper suggest that the novel infant and newborn chest compression technique (nTTT) is not inferior (but not better) compared with standard methods. Previous studies<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–5</span></a> have suggested that nTTT is better in crossover manikin studies than the standard two-finger technique (TFT) and even the recommended two-thumb encircling hands technique (TTHT).</p><p id="par0010" class="elsevierStylePara elsevierViewall">The main advantage of nTTT is to increase the force exerted on the chest during chest compressions; observing the data and Figure 3 (<span class="elsevierStyleItalic">Nueva técnica de los 2 pulgares</span>) in the study published by Dr. Rodriguez-Ruiz et al., we decided to conduct a survey to assess whether the angle of thumbs during chest compressions with nTTT could influence the basic quality parameters of resuscitation. It should be noted that “the novel method of chest compressions in an infant (nTTT) consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist”.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In a randomized manikin crossover study published in the <span class="elsevierStyleItalic">American Journal of Emergency Medicine</span>, all study participants (36 paramedics) performed 2-minute cardiopulmonary resuscitation on an ALS Baby Trainer (Laerdal Medical, Stavanger, Norway) simulating a 3-month-old infant in 2 scenarios.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> In scenario A, the correct nTTT chest compression technique was applied with two thumbs directed at the 90° angle to the chest, and scenario B involved a modified nTTT technique with two thumbs directed at the angle of 45° instead of 90°. The mean depth of chest compressions and the percentage of compressions with correct depth, as well as the percentage of total chest relaxation were found to be superior in scenario A.</p><p id="par0020" class="elsevierStylePara elsevierViewall">It should be emphasized that in the correct, originally described nTTT chest compression technique, two thumbs are directed at the 90° angle to the chest while the fingers of both hands are clenched into fists; other studies should follow the same methods in order to compare the results.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We are very grateful to Dr. Emilio Rodriguez-Ruiz and his colleagues for their study and hope that the new method of infant and newborn chest compressions will be tested in further research.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new chest compression technique in infants" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Rodriguez-Ruiz" 1 => "V. Guerra Martín" 2 => "C. Abelairas-Gómez" 3 => "F. Sampedro Vidal" 4 => "C. Gómez González" 5 => "R. Barcala-Furelos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2018.04.010" "Revista" => array:2 [ "tituloSerie" => "Med Intensiva" "fecha" => "2018" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of new two-thumb chest compression technique for infant CPR performed by novice physicians. A randomized, crossover, manikin trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Smereka" 1 => "L. Szarpak" 2 => "A. 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Ladny" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Medicine" "fecha" => "2017" "volumen" => "96" "paginaInicial" => "5915" "paginaFinal" => "5919" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel method of newborn chest compression: a randomized crossover simulation study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Smereka" 1 => "L. Szarpak" 2 => "J.R. Ladny" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Front Pediatr" "fecha" => "2018" "volumen" => "6" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Smereka" 1 => "M. Kasinski" 2 => "A. Smereka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5603/KP.a2017.0015" "Revista" => array:6 [ "tituloSerie" => "Kardiol Pol" "fecha" => "2017" "volumen" => "75" "paginaInicial" => "589" "paginaFinal" => "595" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28150278" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel method of infant chest compression. Does the arrangement of the thumbs matter?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Ruetzler" 1 => "J. Smereka" 2 => "L. Szarpak" 3 => "M. Czekajlo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajem.2018.08.030" "Revista" => array:2 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "2018" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004300000006/v1_201907250825/S2173572719301134/v1_201907250825/en/main.assets" "Apartado" => array:4 [ "identificador" => "64604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000006/v1_201907250825/S2173572719301134/v1_201907250825/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719301134?idApp=WMIE" ]
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