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Updated: May 16, 2026
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Evaluation of the 2010 American Heart Association Guidelines for infant CPR finger/thumb positions for chest
Ki Hyun Lee1, Eun Young Kim, Dae Hong Park
1School of Medicine, Gachon University, Incheon, Republic of Korea.
Insights
The 2010 American Heart Association Guidelines for infant cardiopulmonary resuscitation (CPR) chest compression landmarks adequately compress the left ventricle (LV) in over 90% of infants. However, upper abdominal compression occurs in 23-35% of cases.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Radiology
Background:
- Current infant cardiopulmonary resuscitation (CPR) guidelines from the American Heart Association (AHA) recommend specific chest compression landmarks.
- The effectiveness of these landmarks in achieving adequate left ventricle (LV) compression and avoiding abdominal compression in infants requires verification.
Purpose of the Study:
- To assess whether the 2010 AHA infant CPR guidelines' recommended chest compression landmarks result in adequate LV compression.
- To determine the incidence of abdominal compression when using these recommended landmarks in infant CPR.
Main Methods:
- Retrospective analysis of computed tomography (CT) examinations of 63 infants.
- Measurement of distances between sternal landmarks (INL, LT) and the xiphoid process.
- Comparison of measured distances with simulated finger placements by adults on infant mannequins for two-finger and two-thumb CPR techniques.
Main Results:
- The left ventricle (LV) was compressed in 90.5% (two-finger) and 93.7% (two-thumb) of infants when applying AHA guidelines.
- Upper abdominal compression occurred in 34.9% (two-finger) and 25.3% (two-thumb) of infants, with depths ranging from 0.3-10.8 mm.
Conclusions:
- The 2010 AHA infant CPR guidelines' recommended finger placement facilitates adequate LV compression in the majority of infants.
- A significant proportion of infants experience some degree of upper abdominal compression with the recommended techniques.
Introduction:
We sought to verify, using computed tomography (CT) examinations of infants, which the left ventricle (LV) is compressed and abdominal compression avoided by using the chest compression landmarks recommended by the 2010 American Heart Association (AHA) Guidelines for infant cardiopulmonary resuscitation (CPR).
Methods:
Using CT examinations of 63 infants performed between March 2002 and July 2011, we retrospectively measured the distance between the INL and the xiphoid process, and the distance of the lower third (LT) of the sternum. The distances between LV maximal diameter (LVMD) and xiphoid processes were also measured to determine whether LVs would be compressed by chest compressions. These distances were compared with the finger placements by 20 adults, when placed on infant mannequins for simulated two-finger or two-thumb infant CPR.
Results:
The mean distances of the INL and the LT of the sternum were 32 ± 8 mm and 12 ± 2 mm from the xiphoid, respectively. The LVMD was placed 15 ± 6 mm from the xiphoid process. When we overlaid the width of adult finger placement (a mean of 28 mm for two-finger technique, and 23 mm for two-thumb technique), the LV was compressed in 57 patients (90.5%) and 59 patients (93.7%), respectively. The upper abdomen was compressed in 22 patients (34.9%) by the two-finger technique and in 16 patients (25.3%) by the two-thumb technique with the range of 0.3-10.8mm.
Conclusion:
When applying the 2010 AHA Guidelines for infant CPR, recommended finger placement allows for adequate compression of the LV in more than 90% of patients. In 23-35% of infants, the upper abdomen is compressed from 0.3mm to 10.7 mm.
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