Elsevier

Resuscitation

Volume 80, Issue 12, December 2009, Pages 1378-1381
Resuscitation

Clinical paper
Optimum location for chest compressions during two-rescuer infant cardiopulmonary resuscitation

https://doi.org/10.1016/j.resuscitation.2009.08.013Get rights and content

Abstract

Objectives

The study aims to evaluate the optimal chest compression site in two-rescuer infant cardiopulmonary resuscitation (CPR).

Methods

Charts and multidirectional computed tomography images of infants who presented to one of four hospitals from March 2004 to March 2009 were reviewed retrospectively. The length of the sternum (Stotal), the length and width (L, W) of adult thumbs after two thumbs were placed side-by-side were measured. The study included the structures located underneath the lower third of Stotal (Stotal/3), the lower half of Stotal (Stotal/2), the sternum at the inter-nipple line (Sn), the point of maximal anterior–posterior heart diameter (Sm), the lower margin of L and the lateral margin of W from Stotal/3, Stotal/2, Sn and Sm.

Results

Of the 75 infants enrolled, the ratio of the length from the xiphoid process to Sm from Stotal was 0.24 ± 0.19. In the population studied, 43.1% had aortic roots in Stotal/2, 44.0% had left ventricular outflow tracts in Stotal/3, 46.7% had left ventricular outflow tracts at Sn and 100.0% had left ventricles at Sm. All the infants had livers in the lower margin of L from Sm and all of them had hearts in the left lateral margin of half of W from Sm. A total of 42.7% had lungs in the right lateral margin of half of W from Sm.

Conclusion

The left ventricle was located in the lower quarter of the sternum, lower than Stotal/3. However, more studies are needed to validate the efficiency and safety of compressing the lower quarter of the sternum in two-rescuer infant CPR.

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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  • European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth

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    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

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    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.

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    2013, Seminars in Fetal and Neonatal Medicine
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    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, Resuscitation
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    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.

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