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What is the potential for over-compression using current paediatric chest compression guidelines? - A chest computed
Gene Yong-Kwang Ong1, Aloysius Jian Feng Ang2, Amirzeb S O Aurangzeb2
1Children's Emergency, KK Women's and Children's Hospital, Singapore.
Insights
Current paediatric chest compression guidelines may lead to over-compression. Simulated compressions based on chest CT scans suggest that recommended depths of 4 cm for infants and 5 cm for young children pose a risk of over-compression, especially when exceeding these limits.
Area of Science:
- Cardiology
- Pediatric Emergency Medicine
- Radiology
Background:
- Current paediatric chest compression depth guidelines are based on limited data.
- Over-compression during cardiopulmonary resuscitation (CPR) can cause significant injury.
- Accurate chest compression depth is crucial for effective paediatric resuscitation.
Purpose of the Study:
- To evaluate the potential for over-compression using current paediatric chest compression depth guidelines.
- To analyze chest computed tomography (CT) images from a large, diverse Asian paediatric population.
- To assess the risk of over-compression at recommended and slightly increased compression depths.
Main Methods:
- Retrospective review of 592 paediatric chest CT scans (2005-2017).
- Measurement of internal and external anterior-posterior diameters (APD) at the lower sternum.
- Simulation of chest compressions to determine residual internal cavity dimensions (RICD) and identify potential over-compression (RICD < 10 mm).
Main Results:
- Simulated compressions of one-third external APD showed minimal over-compression risk (0% infants, 0.3% children).
- A 4 cm compression depth resulted in 18% of infants and 34% at 4.4 cm having potential over-compression.
- A 5 cm compression depth resulted in 8% of children (1-8 years) and 22% at 5.5 cm having potential over-compression.
Conclusions:
- Current recommended chest compression depths of approximately 4 cm (infants) and 5 cm (young children) may lead to potential over-compression.
- The risk of over-compression increases when compression depths exceed recommended guidelines.
- Accurate measurement of chest compression depth is critical in paediatric CPR settings.
Aim:
We explored the potential for over-compression from current paediatric chest compression depth guidelines using chest computed tomography(CT) images of a large, heterogenous, Asian population.
Methods:
A retrospective review of consecutive children, less than 18-years old, with chest CT images performed between from 2005 to 2017 was done. Demographic data were extracted from the electronic medical records. Measurements for internal and external anterior-posterior diameters (APD) were taken at lower half of the sternum. Simulated chest compressions were performed to evaluate the proportion of the population with residual internal cavity dimensions less than 0 mm (RICD < 0 mm, representing definite over-compression; with chest compression depth exceeding internal APD), and RICD less than 10 mm (RICD < 10 mm, representing potential over-compression).
Results:
592 paediatric chest CT studies were included for the study. Simulated chest compressions of one-third external APD had the least potential for over-compression; no infants and 0.3% children had potential over-compression (RICD < 10 mm). 4 cm simulated chest compressions led to 18% (95% CI 13%-24%) of infants with potential over-compression, and this increased to 34% (95% CI 27%-41%) at 4.4 cm (upper limit of "approximately" 4 cm; 4 cm + 10%). 5 cm simulated compressions resulted in 8% (95% CI 4%-12%) of children 1 to 8-years-old with potential over-compression, and this increased to 22% (95% CI 16%-28%) at 5.5 cm (upper limit of "approximately" 5 cm, 5 cm + 10%).
Conclusion:
In settings whereby chest compression depths can be accurately measured, compressions at the current recommended chest compression of approximately 4 cm (in infants) and 5 cm (in young children) could result in potential for over-compression.
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