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Updated: Jun 23, 2025
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Optimal Chest Compression Point During Pediatric Resuscitation: Implications for Pediatric Resuscitation Practice by
Christine Eimer1, Monika Huhndorf2, Ole Sattler2
1Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Insights
Current European guidelines suggest the lower sternum for pediatric cardiopulmonary resuscitation (CPR) chest compressions. This study found the optimal chest compression point (CP) is often lower, suggesting adjustments for improved CPR effectiveness in children.
Area of Science:
- Pediatric Emergency Medicine
- Cardiopulmonary Resuscitation Research
- Thoracic Anatomy Imaging
Background:
- Current European guidelines recommend the lower half of the sternum as the chest compression point (CP) for pediatric cardiopulmonary resuscitation (CPR).
- Accurate CP is crucial for effective CPR, necessitating anatomical correlation.
Purpose of the Study:
- To evaluate the recommended CP against cardiac anatomy using thoracic CT scans in children.
- To determine the optimal CP for pediatric CPR based on anatomical structures.
Main Methods:
- Analysis of 290 pediatric thoracic CT scans from patients aged 3-16 years.
- Measurement and analysis of 14 thoracic metrics per scan.
- Comparison of recommended CP with cardiac ventricular levels and anatomical landmarks.
Main Results:
- In 15.2% of scans, the recommended CP did not align with cardiac ventricles.
- The optimal CP was anatomically one rib or vertebral body lower than recommended in 23.1% of cases.
- Recommended compression depth is adequate for <12 years; a 6cm limit is suitable for ≥12 years.
Conclusions:
- Optimal CP for pediatric CPR is often more caudal than currently recommended.
- Utilizing the lower sternum for chest compressions may enhance CPR efficacy.
- A compression depth limit of 6cm, similar to adults, is appropriate for older children (≥12 years).
Objectives:
Current European guidelines for pediatric cardiopulmonary resuscitation (CPR) recommend the lower half of the sternum as the chest compression point (CP). In this study, we have used thoracic CT scans to evaluate recommended and optimal CP in relation to cardiac anatomy and structure.
Design:
Analysis of routinely acquired thoracic CT scans acquired from 2000 to 2020.
Setting:
Single-center pediatric department in a German University Hospital.
Patients:
Imaging data were obtained from 290 patients of 3-16 years old.
Interventions:
None.
Measurements And Main Results:
We measured and analyzed 14 thoracic metrics in each thoracic CT scan. In 44 of 290 (15.2%) scans, the recommended CP did not match the level of the cardiac ventricles. Anatomically, the optimal CP was one rib or one vertebral body lower than the recommended CP, that is, the optimal CP was more caudal to the level of the body of the sternum in 67 of 290 (23.1%) scans. The recommended compression depth appeared reasonable in children younger than 12 years old. At 12 years old or older, the maximum compression depth of 6 cm is less than or equal to one-third of the thoracic depth.
Conclusions:
In this study of thoracic CT scans in children 3-16 years old, we have found that optimal CP for CPR appears to be more caudal than the recommended CP. Therefore, it seems reasonable to prefer to use the lower part of the sternum for CPR chest compressions. At 12 years old or older, a compression depth similar to that used in adults-6 cm limit-may be chosen.
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History: