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Cardiopulmonary resuscitation in pediatric pectus excavatum patients-Where is the heart?

Young-Eun Jang1, Jung-Bin Park1, Chang-Hyun Kang2

  • 1Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Korea.

Paediatric Anaesthesia
|April 17, 2020
PubMed

Insights

Chest compressions for pediatric pectus excavatum patients may be ineffective and dangerous. Current cardiopulmonary resuscitation guidelines may cause injury due to heart displacement in these patients.

Area of Science:

  • Pediatric Cardiology
  • Thoracic Surgery
  • Cardiopulmonary Resuscitation

Background:

  • Pectus excavatum involves a depressed sternum that can compress and displace the heart in children.
  • Optimal cardiopulmonary resuscitation (CPR) techniques for these patients are not well-established.

Purpose of the Study:

  • To determine the optimal site and depth for chest compressions in pediatric pectus excavatum patients.
  • To investigate ventricle displacement in relation to the sternum using CT imaging.

Main Methods:

  • Retrospective analysis of chest CT scans from 94 pediatric pectus excavatum patients (pre- and post-surgery) and normal controls.
  • Calculation of ventricular caudal displacement and leftward deviation relative to thoracic dimensions.
  • Assessment of remaining internal thickness at the recommended CPR compression depth.

Main Results:

  • Pectus excavatum patients exhibited significant caudal displacement (98.2% pre-op, 100.4% post-op) and leftward ventricular deviation (16.2% pre-op, 13.3% post-op) compared to controls.
  • Recommended CPR compression depth (<10 mm remaining thickness) was insufficient in 57.4% pre-op and 19.1% post-op patients.
  • Significant differences persisted even after surgical correction.

Conclusions:

  • Children with pectus excavatum have significantly displaced ventricles, both before and after surgical correction.
  • Current CPR recommendations for compression site and depth may pose risks of intrathoracic injury and ineffective cardiac compression in this population.
Abstract

Keywords:
cardiopulmonary resuscitationpectus excavatumpediatrics

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