Hand position matters when novice rescuers perform CPR

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Novice rescuers doing CPR should contact the victim's sternum with the same hand as the side of the body from which they approach, regardless of handedness, Korean researchers say.

In a manikin study, they found that rescuers on the victim's left side gave deeper compressions using their left hand against the sternum instead of their right, even if they were right-handed -- and vice versa.

"In CPR training and real world situations, a novice rescuer, regardless of handedness, should consider hand positions for contacting the sternum identical to the side of approach," Dr. SeungWhan Kim from Chungnam National University Hospital in Daejeon and colleagues wrote online October 14 in the Emergency Medicine Journal.

But until these findings can be confirmed, it's important for rescuers to approach from the side of their dominant hand, says one expert not involved with the research.

The new study included 34 right-handed and 10 left-handed student volunteers without previous CPR experience. In a crossover design, volunteers were randomly assigned approach from the manikin's left with the rescuer's left hand in contact with the sternum (Lap/Lst), from the manikin's left with rescuer's right hand contacting the sternum (Lap/Rst), from the manikin's right with the rescuer's left hand contacting the sternum (Rap/Lst) and from the manikin's right with the rescuer's right hand contacting the sternum (Rap/Rst).

Regardless of their handedness, the rescuers delivered deeper chest compressions if they contacted the manikin's sternum with the same hand as the side of the manikin they were on.

In other words, rescuers on the left side gave deeper compressions using their left hand against the sternum, and rescuers on the right side gave deeper compressions using their right hand.

When the researchers compared the quality of chest compressions between the right- and left-handed students according to each method and position for chest compression, only the Rap/Lst group showed a significant decrease in mean compression depth between the two groups, regardless of hand dominance. The frequency of correct hand placement was lower in the Lap/Rst position for left-handed students. RH novice rescuers preferred the Rap/Rst position (35.3%) and LH rescuers the Lap/Lst position (60.0%).

"Until now, no studies on dominant versus non-dominant hand position and the rescuer's side of approach have been available. We found that some differences are present, but further investigation should be undertaken on this topic by other researchers," Dr. SeungWhan told Reuters Health by email.

Dr. Ryan Stanton, spokesperson for the American College of Emergency Physicians and an emergency physician with the Mesa Medical Group in Lexington, Kentucky, told Reuters Health that the new study is "relatively small."

It's not clear yet, he says, whether the data can be reproduced in larger trials or in real-world settings. In the meantime, he emphasizes the importance of handedness.

"The dominant hand matters in CPR, especially in early training. We're learning that handedness makes a difference in the quality of CPR," he told Reuters Health.

"We know the importance of CPR, which is moving toward chest compression after it's been found that chest compression is much more important than giving breaths. If you're right or left handed is also important, and that may be integral to maximizing the setup of the response and code teams, knowing who should be on which side to give the person the best chance of survival," he said.

Observing that most physicians who do significant hospital work have average competence with CPR, Dr. Stanton added that "people, especially novices, should be taught that you need to approach from the same side as your dominant hand."

The new findings from Korea, Dr. Stanton said, are "food for thought, to get the wheels of research turning and decide if this is something we need to put a lot of thought in or not."

SOURCE: http://bit.ly/1bbT9pF

Emerg Med J 2013.

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