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Published on: April 18, 2013
Estimation of anatomical structures underneath the chest compression landmarks in children by using computed
Yoo Seok Park1, Incheol Park, Young Jin Kim
1Department of Emergency Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, 120-752 Seoul, Republic of Korea.
Insights
Current guidelines for paediatric cardiopulmonary resuscitation (CPR) hand placement may be suboptimal. Anatomical CT imaging suggests the inter-nipple line may be too high and the lower sternum too low for effective chest compressions.
Area of Science:
- Pediatric Emergency Medicine
- Cardiopulmonary Resuscitation
- Medical Imaging
Background:
- Chest compression hand placement in pediatric cardiopulmonary resuscitation (CPR) lacks thorough investigation.
- Existing guidelines may not ensure optimal effectiveness or safety.
Purpose of the Study:
- To identify anatomical structures beneath recommended CPR hand positions in children.
- To determine optimal hand placement for effective pediatric CPR using CT imaging.
Main Methods:
- Computed tomography (CT) scans of 181 pediatric patients were analyzed.
- Structures under the inter-nipple line and lower sternum were identified.
- Distances from the xiphoid process to the left ventricular outflow tract (LVOT) were measured.
Main Results:
- The left ventricular outflow tract (LVOT) and aortic root were common structures under the inter-nipple line.
- The liver was frequently located under the lower third of the sternum (28.7%).
- The LVOT was an average of 6.8 mm below nipple level, with no significant age-related difference.
Conclusions:
- The inter-nipple line hand position may be too superior, and the lower sternum position too inferior, potentially compressing the liver.
- Further research is required to establish precise hand positioning for improved pediatric CPR outcomes.
Objective:
There has been little investigation on the appropriateness of the hand position suggested by various guidelines in paediatric cardiopulmonary resuscitation (CPR). We aimed to identify anatomical structures underneath the chest compression landmarks and tried to find the proper hand position using computed tomography (CT) images for more effective paediatric CPR.
Patients And Methods:
This study included a total of 181 paediatric patients who were admitted to Severance Hospital and underwent CTs of chest. We studied structures located under the inter-nipple line and under the lower third of the sternum. The distances from the xiphoid process to the level of the left ventricular outflow tract (LVOT) were measured to find the ceiling on the proper hand position.
Results:
The LVOT (42.0%) and the root of the aorta (21.5%) were more frequently located than the left ventricle under the inter-nipple line, and the liver was located under the lower third of the sternum in a significant number of patients (28.7%). The LVOT was placed 6.8±13.9 mm below the nipple level, but there was no significant difference in the distance from the nipple level to the LVOT among the age groups (p=0.517).
Conclusions:
The hand position at the inter-nipple line might be too high and that at the lower third of the sternum might be too low as it can compress the liver. Further studies are needed to find the proper hand position for more effective chest compression during paediatric CPR.
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