Optimum position for external cardiac compression in infants and young children

Ninety-seven pediatric patients (age less than 17 years) undergoing routine upright chest roentgenograms in the posteroanterior projection and 90 children undergoing supine anteroposterior chest roentgenograms had lead markers placed at the suprasternal notch and xiphoid prior to taking the roentgenograms. The position of the geometric center of the cardiac silhouette in relation to the sternum was recorded as a percentage of the distance along the sternum. The heart lies under the lower one-third of the sternum (greater than 67%) in all cases at all ages. Ten pediatric patients (between 1 month and 3 years of age) who sustained cardiac arrest while in the Pediatric and Surgical Intensive Care Unit and who had arterial pressure monitoring lines already in place were monitored with a two- or four-channel strip-chart recorder during external cardiac compression (ECC) performed by staff members who were blinded from the results of the strip-chart recording. The ECC performers were instructed to perform ECC at either the midsternum at the level of the victim's nipples or at the lower one-third of the sternum 1.5 to 2 cm above the tip of the xiphoid, and then to switch on command. In every instance in which the patients served as their own controls (ECC performed at both the midsternum and lower one-third of the sternum in random sequence), the performance of ECC over the lower one-third of the sternum resulted in significantly better systolic and mean arterial blood pressures (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)