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The optimum chest compression site with regard to heart failure demonstrated by computed tomography
Keunha Hwang1, Sung-Bin Chon1, Jung Gi Im2
1Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Gyeonggi-Do, Republic of Korea.
Insights
For cardiopulmonary resuscitation (CPR), compress the sternum just above the xiphisternal joint, especially for heart failure (HF) patients. This optimizes chest compression site and improves outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Emergency Medicine
Background:
- Determining optimal chest compression site during cardiopulmonary resuscitation (CPR).
- Investigating the impact of heart failure (HF) on compression site efficacy.
- Utilizing three-dimensional (3D) coordinates from computed tomography (CT) for anatomical assessment.
Purpose of the Study:
- To identify the ideal chest compression location during CPR in patients with heart failure (HF).
- To analyze the anatomical differences affecting CPR efficacy in HF patients using 3D CT imaging.
Main Methods:
- Retrospective, cross-sectional study of adult patients undergoing echocardiography and CT.
- Exclusion of incomplete data, HF information, or thoracic abnormalities.
- Establishment of a 3D coordinate system with the xiphisternal joint as the reference point to locate the maximum left ventricular (LV) diameter midpoint (P_max.LV).
Main Results:
- HF patients had P_max.LV located significantly more leftward, lower, and deeper than non-HF patients (p<0.05).
- Fewer HF patients (59.2%) experienced LV compression compared to non-HF patients (77.8%) under current guidelines (p=0.025).
- Aorta compression occurred in 85.5% of HF and 81.9% of non-HF cases at 3 cm above the xiphisternal joint; at 6 cm, all patients had direct aortic compression.
Conclusions:
- The optimal chest compression site during CPR, particularly for HF patients, is the lower sternum just above the xiphisternal joint.
- Current CPR guidelines may lead to suboptimal compression of the left ventricle in HF patients.
- Targeting the lower sternum may improve CPR effectiveness by avoiding aortic compression and increasing LV engagement.
Background:
To determine the optimum chest compression site during cardiopulmonary resuscitation (CPR) with regard to heart failure (HF) by applying three-dimensional (3D) coordinates on computed tomography (CT).
Methods:
This retrospective, cross-sectional study involved adults who underwent echocardiography and CT on the same day from 2007 to 2017. Incomplete CT images or information on HF, cardiac medication between echocardiography and CT, or thoracic abnormalities were excluded. Cases were checked whether they had HF through symptom/sign assessment, N-terminal pro-B type natriuretic peptide, and echocardiography. We set the xiphisternal joint's midpoint as the reference (0, 0, 0) to draw a 3D coordinate system, designating leftward, upward, and into-the-thorax directions as positive. The coordinate of the maximum LV diameter's midpoint (P_max.LV) was identified.
Results:
Enrolled were 148 patients (63.0±15.1 years) with 87 females and 76 HF cases. P_max.LV of HF cases was located more leftwards, lower, and deeper than non-HF cases (5.69±0.98, -1.51±1.67, 5.76±1.09 cm vs. 5.00±0.83, -0.99±1.36, 5.25±0.71 cm, all p<0.05). Fewer HF cases had their LV compressed than non-HF cases (59.2% vs. 77.8%, p=0.025) when being compressed according to the current guidelines. The aorta (vs. LV) was compressed in 85.5% and 81.9% of HF and non-HF cases, respectively, at 3 cm above the xiphisternal joint. At 6cm above the joint, the highest allowable position according to the current guidelines, all victims would have their aorta compressed directly during CPR rather than the LV.
Conclusions:
The lowest possible sternum just above the xiphisternal joint should be compressed especially for HF patients during CPR.