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Updated: Feb 18, 2026
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Verification of the Optimal Chest Compression Depth for Children in the 2015 American Heart Association Guidelines:
Yong Hwan Kim1, Jun Ho Lee1, Kwang Won Cho1
1Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
Insights
Pediatric chest compressions: 5cm depth risks overcompression in younger children, while one-third chest depth is safer for them. Older children may exceed adult limits with one-third depth.
Area of Science:
- Pediatric Emergency Medicine
- Cardiopulmonary Resuscitation
- Medical Imaging (CT)
Background:
- Current guidelines recommend pediatric chest compressions of at least 5 cm (one-third of chest diameter).
- The safety of this 5 cm depth versus one-third anteroposterior (AP) diameter compression needs evaluation in pediatric populations.
Purpose of the Study:
- To compare the safety of two pediatric chest compression depths: 5 cm and one-third of the anteroposterior (AP) chest diameter.
- To evaluate the risk of overcompression in children aged 1-9 years using CT-simulated compression depths.
Main Methods:
- Retrospective study analyzing CT scans of 349 pediatric patients (1-9 years old).
- Simulated chest compression depths of 5 cm and one-third AP diameter.
- Measured chest dimensions and calculated overcompression rates based on age-specific safe cutoff levels.
Main Results:
- A 5 cm compression depth resulted in overcompression in 16% of children, significantly higher in 1-3 year olds compared to 4-9 year olds.
- One-third AP diameter compression caused overcompression in only 0.3% of subjects.
- However, one-third AP diameter exceeded 6 cm (adult upper limit) in 16.1% of 8-year-olds and 33.3% of 9-year-olds.
Conclusions:
- For younger Korean children (1-3 years), one-third AP chest compression depth may be safer than a fixed 5 cm depth.
- For older Korean children (8-9 years), one-third AP depth compression risks exceeding the recommended adult upper limit.
Objective:
The 2015 American Heart Association guidelines recommended pediatric rescue chest compressions of at least one-third the anteroposterior diameter of the chest, which equates to approximately 5 cm. This study evaluated the appropriateness of these two types by comparing their safeties in chest compression depth simulated by CT.
Design:
Retrospective study with data analysis conducted from January 2005 to June 2015 SETTING:: Regional emergency center in South Korea.
Patients:
Three hundred forty-nine pediatric patients 1-9 years old who had a chest CT scan.
Interventions:
Simulation of chest compression depths by CT.
Measurements And Main Results:
Internal and external anteroposterior diameter of the chest and residual internal anteroposterior diameter after simulation were measured from CT scans. The safe cutoff levels were differently applied according to age. One-third external anteroposterior diameters were compared with an upper limit of chest compression depth recommended for adults. Primary outcomes were the rates of overcompression to evaluate safety. Overcompression was defined as a negative value of residual internal anteroposterior diameter-age-specific cutoff level. Using a compression of 5-cm depth simulated by chest CT, 16% of all children (55/349) were affected by overcompression. Those 1-3 years old were affected more than those 4-9 years old (p < 0.001). Upon one-third compression of chest anteroposterior depth, only one subject (0.3%) was affected by overcompression. Rate of one-third external anteroposterior diameter greater than 6 cm in children 8 and 9 years old was 16.1% and 33.3%, respectively.
Conclusions:
A chest compression depth of one-third anteroposterior might be more appropriate than the 5-cm depth chest compression for younger Korean children. But, one-third anteroposterior depth chest compression might induce deep compressions greater than an upper limit of compression depth for adults in older Korean children.
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