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Updated: May 29, 2025
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Comparing sternal versus left-sided chest compressions for thoracoabdonimal injuries and compression biomechanics: A
J Gould1, R A Marshall2, D French3
1Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.
Insights
Left-sided chest compressions cause more thoracoabdominal injuries than standard CPR. This study in cadavers found increased rib fractures and flail chest with left-sided methods, warranting further investigation.
Area of Science:
- Cardiovascular Research
- Biomedical Engineering
- Trauma Research
Background:
- Current cardiopulmonary resuscitation (CPR) guidelines recommend chest compressions on the lower half of the sternum.
- This standard area of compression (AOC) can lead to left ventricular outflow obstruction and inadequate cardiac pumping.
- Alternative left-sided chest compression techniques aim to improve left ventricular compression but carry unknown risks.
Purpose of the Study:
- To investigate the biomechanics and thoracoabdominal injury patterns associated with left-sided chest compressions compared to standard sternal compressions.
- To evaluate the safety and feasibility of alternative chest compression strategies in CPR.
Main Methods:
- Six clinical-grade cadavers were used, with 2 for standard compressions and 4 for left-sided compressions.
- Chest compressions were standardized for depth, rate, and recoil using feedback devices over six 2-minute rounds.
- Intermittent fluoroscopy monitored biomechanics, and post-CPR dissection assessed thoracoabdominal injuries.
Main Results:
- Left-sided compressions resulted in significantly higher rates of rib fractures (100%) and flail chest segments (75%) compared to standard compressions (50% rib fractures).
- Internal thoracic artery injury occurred in 25% of left-sided compression cases.
- No abdominal organ injuries were observed in either group. Chest wall deformity patterns differed significantly between standard and left-sided compressions.
Conclusions:
- Left-sided chest compressions, while potentially targeting the left ventricle, consistently caused more severe rib fractures and flail chest injuries in this cadaveric study.
- The findings suggest a higher risk profile for left-sided compressions, necessitating cautious interpretation due to the small sample size.
- Further research is crucial to fully understand the biomechanics and clinical outcomes of left-sided chest compressions before considering them for widespread use.
Background:
The lower half of the sternum is currently recommended as the area of compression (AOC) in CPR. Compressions over this area often result in outflow obstruction and inadequate compression of the left ventricle. Alternative left-sided chest compressions that target the left ventricle may improve cardiac arrest outcomes. However, little is known about the risks of thoracoabdominal injuries or the biomechanics of left-sided compressions.
Methods:
The objective of this study was to examine the thoracoabdominal injury patterns and compression biomechanics during standard (control) and left-sided (experimental; off sternum, patient left, 6th rib) chest compressions. N = 6 clinical-grade cadavers (control n = 2; experimental n = 4) underwent six 2-minute rounds of chest compressions with intermittent fluoroscopy. Chest compression depth, recoil, and rate were standardized using compression feedback devices. Post-CPR dissection was used to examine for thoracoabdominal injuries.
Results:
Standard compressions resulted in rib fractures (n = 1 [50%]). Left-sided compressions resulted in rib fractures (n = 4 [100%]), flail chest segments (n = 3 [75%]), and internal thoracic artery injury (n = 1 [25%]). No abdominal organ injuries were identified in either group (N = 6 [0%]). During compression, each condition yielded a different pattern of chest wall deformity (standard - regular trapezoid [midline, comparable left-right sides, flat top, and bottom]; left-sided - irregular trapezium [left-sided, unequal sides, leftward sloped top]).
Conclusion:
Experimental left-sided compressions consistently produced rib fractures and flail chest segments. Findings should be interpreted with caution due to the limited sample size. Further studies investigating the biomechanics and outcomes of left sided chest compressions are warranted.
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