Safety Evaluation of an Alternative Chest Compression Landmark for Cardiopulmonary Resuscitation: A Cadaveric...

Out-of-hospital cardiac arrest (OHCA) remains a significant global health challenge. Cardiopulmonary resuscitation (CPR) plays a pivotal role in patient survival; the International Liaison Committee on Resuscitation (ILCOR) recommends compressions on the lower half of the sternum. However, emerging evidence suggests that performing compressions below this point, directly targeting the maximal diameter of the left ventricle, may improve cardiac output and clinical outcomes. This study assessed the safety of the new compression landmark by comparing complications with the standard approach.

This study was conducted as a randomized controlled trial using cadavers. The cadavers were assigned to two groups: The alternative landmark group received a mechanical chest compression cup that was placed 12.6 cm below the sternal notch, targeting the maximal diameter of the left ventricle. The nonintervention group used the standard landmark (lower half of the sternum). Each cadaver underwent pre- and post-chest compression computed tomography scans, followed by an autopsy to identify and compare complications. The primary outcome was the incidence of serious injuries. Secondary outcomes included the incidence of organ-specific injuries.

Forty-two cadavers were equally assigned into two groups (21 per group). Serious injuries occurred similarly in the alternative and standard landmark groups (61.90% vs. 66.67%, p = 0.747). Rib cage injuries were similar between groups 11 (52.38%) versus 13 (61.90%) (p = 0.533). Flail chest affected 1 (4.76%) versus 3 (14.29%) (p = 0.293), and heart injuries were 2 (9.52%) versus 0 (p = 0.147). Skeletal fractures were universal, with sternal fractures in 16 (76.19%) versus 15 (71.43%) (p = 0.726). Visceral injuries were 7 (33.33%) versus 4 (19.05%) (p = 0.292). Liver and spleen injuries occurred only in the standard group (0% versus 4.76%, p = 0.312). No kidney injuries were reported.

The alternative landmark showed no significant difference in serious injuries compared to the standard landmark. Further studies should focus on chest compression at the new landmark, which has the potential to improve cardiac arrest outcomes.