Original contribution
Optimum position for external cardiac compression in infants and young children

https://doi.org/10.1016/S0196-0644(86)80423-1Get rights and content

Ninety-seven pediatric patients (age < 17 years) undergoing routine upright chest roentgenograms in the posteroanterior projection and 90 children undergoing supine anteroposterior chest roentgenograms had lead markers placed at the suprasternal notch and xiphoid prior to taking the roentgenograms. The position of the geometric center of the cardiac silhouette in relation to the sternum was recorded as a percentage of the distance along the sternum. The heart lies under the lower one-third of the sternum (> 67%) in all cases at all ages. Ten pediatric patients (between 1 month and 3 years of age) who sustained cardiac arrest while in the Pediatric and Surgical Intensive Care Unit and who had arterial pressure monitoring lines already in place were monitored with a two- or four-channel strip-chart recorder during external cardiac compression (ECC) performed by staff members who were blinded from the results of the strip-chart recording. The ECC performers were instructed to perform ECC at either the midsternum at the level of the victim's nipples or at the lower one-third of the sternum 1.5 to 2 cm above the tip of the xiphoid, and then to switch on command. In every instance in which the patients served as their own controls (ECC performed at both the midsternum and lower one-third of the sternum in random sequence), the performance of ECC over the lower one-third of the sternum resulted in significantly better systolic and mean arterial blood pressures (P < .001). There were no instances of liver or other organ injury from ECC applied to the lower one-third of the sternum, either at autopsy (in five of six cases) or as evidenced by survival of the remaining four cases. The data suggest that ECC performed on infants and young children over the lower one-third of the sternum, 1.5 to 2 cm above the xiphoid, is superior to ECC performed at the midsternum, as measured by arterial blood pressures.

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This study was supported by RPC Grant #1387 of The Cleveland Clinic Foundation.

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