Clinical paperOptimum location for chest compressions during two-rescuer infant cardiopulmonary resuscitation☆
Section snippets
Methods
Charts and MDCT scans of infants who presented to one of four hospitals (i.e., Chungnam National University Hospital, Konyang University Hospital, Chonnam National University Hospital and Chungbuk National University Hospital) from March 2004 to March 2009 were reviewed retrospectively. Exclusion criteria were infants who were not within normal percentile height and body weight, who had diseases that could shift mediastinal organs (such as atelectasis, cardiac abnormality, space-occupying
General characteristics of patients and rescuers
This study enrolled 75 infants with a mean age of 4.43 ± 3.55 months. Of the infants studied, 47 were boys (62.7%). The distributions of all measured data were normal except for that of age, which was measured in months. The mean height and body weight were 61.87 ± 8.77 cm and 6.31 ± 2.42 kg, respectively. The mean Stotal was 5.68 ± 2.00 cm and the respective lengths from the xiphoid process to Stotal/2, Sn, Stotal/3 and Sm were 2.84 ± 1.00 cm, 2.11 ± 1.47 cm, 1.89 ± 0.67 cm and 1.43 ± 1.18 cm. The mean ratio of the
Discussion
To achieve highly successful CPR, some conditions are essential to reduce organ injuries by chest compression and to generate a higher cardiac output. Based on radiograph imaging, one study reported that the heart of a child (younger than 19 months) was located under the lower one-third of the sternum.13 Based on radiograph and angiography imaging, another study also reported that the heart of a child was located under the lower one-third of the sternum.14 Orlowski9 claimed that systolic blood
Conclusion
In conclusion, the left ventricle is located in the lower quarter of the sternum. To determine whether the lower quarter of the sternum is the optimal site of chest compression to perform successful CPR and minimise organ damage, further studies are needed to compare compression of the lower quarter of the sternum with compression of the lower third of the sternum in real two-rescuer infant CPR.
Conflict of interest statement
The author declares no proprietary, financial, professional or other personal interest of nature or kind in any product, service, company that could be construed as influencing the position presented in the article entitled.
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Cited by (22)
European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth
2021, ResuscitationCitation Excerpt :In a manikin study, overlapping the thumbs on the sternum was more effective than adjacent positioning but more likely to cause fatigue.295 The sternum is compressed to a depth of approximately one-third of the anterior-posterior diameter of the chest allowing the chest wall to return to its relaxed position between compressions.296–300 Delivering compressions from ‘over the head’ appears as effective as the lateral position.301
Part 7: Neonatal resuscitation. 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations
2015, ResuscitationCitation Excerpt :In addition, blood pressure readings were higher when cardiac compressions were applied to the lower versus the middle third of the sternum. Use of the infant computed tomography (CT) scan data (mean age, 4.4 months) and adult thumb side-by-side measurements on manikins203 confirmed that the left ventricle lies mostly under the lower quarter of the sternum. No functional data were collected to confirm better outcomes if compressions focused on that area.
Factors modulating effective chest compressions in the neonatal period
2013, Seminars in Fetal and Neonatal MedicineCitation Excerpt :One author demonstrated better arterial pressures (systolic and mean arterial pressures) with chest compressions performed on the lower third of the sternum, noted as 1.5–2 cm above the tip of the xiphoid [40]. A second study conducted a retrospective review of charts and multidirectional computed tomography images of structures underneath different compression sites (lower third, lower half, sternum at inter-nipple line, point of maximum AP heart diameter) relative to the size of an adult thumb during infant CPR [41]. It was hypothesized that compressing the lower quarter of the infant's sternum would generate a higher cardiac output by squeezing the heart at the level of the left ventricle (the maximum AP heart diameter).
A comparison of the area of chest compression by the superimposed-thumb and the alongside-thumb techniques for infant cardiopulmonary resuscitation
2011, ResuscitationCitation Excerpt :Our institutional review board approved the study protocol and deemed it appropriate for exemption from informed consent. As in a previous study,7 the following exclusion criteria were used: infants who were not within the normal percentile for height and body weight, had diseases that could shift mediastinal organs (e.g., atelectasis, cardiac abnormality, space-occupying mediastinal mass, spinal deformity, ascites, pneumothorax, or haemothorax), had undergone previous chest surgery or abdominal surgery, raised their arms when the MDCT scans were taken, and whose nipples were not in the same transverse section on the MDCT scan were excluded. The MDCT used in this study was performed with Somatom Plus 4 (Siemens, Erlangen, Germany), Sensation Cardiac 64 (Siemens, Forchheim, Germany), HiSpeed/I (GE Medical Systems, Milwaukee, MN, USA) and Brilliance 64 (Phillips, Eindhoven, The Netherlands).
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.08.013.