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Should paediatric chest compression depth targets consider body habitus? - A chest computed tomography imaging study
Gene Yong-Kwang Ong1,2, Aloysius Jian Feng Ang1, Zhao Jin Chen3
1Children's Emergency, KK Women's and Children's Hospital, Singapore.
Resuscitation Plus
|February 4, 2022
Summary
Pediatric chest compression depth guidelines need validation, as body size impacts measurements. Overweight and obese children, especially infants and adolescents, show poor concordance between external measurements and required compression depths.
Area of Science:
- Pediatric Resuscitation Science
- Thoracic Anatomy and Biomechanics
- Medical Imaging Analysis
Background:
- Current pediatric chest compression guidelines rely on age-specific depth targets.
- The accuracy of external landmarks for determining internal chest compression depth is not well-established across diverse pediatric body habitus.
- Understanding the relationship between external and internal anterior-posterior diameters (APD) is crucial for effective cardiopulmonary resuscitation (CPR).
Purpose of the Study:
- To investigate how pediatric body habitus influences the accuracy of using one-third external anterior-posterior (APD) diameter for chest compression depth.
- To explore the relationship between external and internal APD (compressible space) in relation to body habitus.
- To determine if body mass index (BMI) and weight-for-length (WFL) predict internal APD at the sternum's lower half.
Main Methods:
- Secondary analysis of retrospective chest computed tomography (CT) scans from 2005-2017.
- Evaluation of internal and external APDs at the mid-point of the lower sternum in infants and children (>24 hours to <18 years).
- Extraction of body habitus and epidemiological data from electronic medical records.
Main Results:
- Poor concordance was observed between one-third external APD and age-specific compression depth targets, particularly in infants and overweight/obese adolescents.
- A co-dependent relationship exists between external and internal APD measurements.
- Overweight/obese children and adolescents exhibited significantly different internal and external APDs compared to normal/underweight groups. BMI was an independent predictor of internal APD (p=0.009), unlike WFL in infants (p=0.511).
Conclusions:
- External and internal APD correlations are influenced by BMI, but not WFL in infants.
- Current chest compression guidelines require validation, especially for infants and overweight/obese adolescents.
- Further clinical studies are necessary to refine pediatric CPR protocols based on body habitus.
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