Chest compression in newborn infants: what anatomical structures are we compressing?

Area of Science:

• Neonatal Cardiology
• Pediatric Resuscitation
• Echocardiography

Background:

• Accurate landmarking for chest compressions (CCs) in neonates is critical for effective resuscitation.
• The precise location of the left ventricle (LV) in newborns during CCs is not well-defined.

Purpose of the Study:

• To determine the anatomical location of the left ventricle (LV) in newborn infants.
• To identify structures compressed by chest compressions (CCs) in the lower sternum region using transthoracic echocardiography.

Main Methods:

• Prospective observational cohort study involving 50 newborn infants.
• Transthoracic echocardiography was used to visualize cardiac structures.
• Standard echocardiographic views were obtained according to American Society of Echocardiography guidelines.

Main Results:

• The left ventricle (LV) was rarely located at the third left sternal border (2%).
• In most newborns, the LV was located more laterally, at the fourth (44%), fifth (50%), or sixth (4%) left sternal border.
• Chest compressions at the lower third of the sternum may not effectively target the LV.

Conclusions:

• Current chest compression (CC) guidelines for newborns may inadvertently target the right heart, great veins, and aorta instead of the left ventricle (LV).
• Further research is needed to optimize CC placement in neonatal resuscitation.