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Transthoracic echocardiography is superior to AHA guidelines location in identifying the left ventricle for chest
Neil Krulewitz1, Miles Lamberson1, Ryan Walsh1
1University of Vermont Larner College of Medicine, 111 Colchester Ave, Burlington, VT 05401, United States.
Insights
Transthoracic echocardiography (TTE) can accurately guide chest compressions to the mid-left ventricle (mid-LV), improving accuracy over standard American Heart Association (AHA) guidelines. This TTE-guided approach may optimize CPR effectiveness.
Area of Science:
- Cardiology
- Medical Imaging
- Emergency Medicine
Background:
- Standard cardiopulmonary resuscitation (CPR) guidelines recommend chest compressions over the lower sternum.
- This standard practice may lead to compressions over the left ventricular outflow tract (LVOT) or aorta, potentially impeding blood flow.
- Previous studies suggest improved outcomes with compressions directed over the left ventricle.
Purpose of the Study:
- To evaluate the accuracy of transthoracic echocardiography (TTE) in identifying the mid-left ventricle (mid-LV).
- To compare the TTE-guided mid-LV localization with the standard American Heart Association (AHA) compression site using computed tomography (CT).
Main Methods:
- Prospective observational study involving adults undergoing chest CT.
- Providers marked the AHA-recommended compression site and used TTE to localize the mid-LV.
- Radiopaque markers were placed at both locations and compared to CT-identified true mid-LV positions.
Main Results:
- The mean distance from the AHA location to the true mid-LV was 74.2 mm.
- The mean distance from the TTE-guided mid-LV marker to the true mid-LV was 64.6 mm.
- The AHA position was found to be cranial and medial to the true mid-LV, with the ascending aorta most commonly beneath the AHA marker (38.5%).
Conclusions:
- TTE-guided localization of the mid-LV is feasible and more accurate than the standard AHA landmark.
- Accuracy is enhanced when TTE is performed by trained providers.
- A TTE-guided approach may optimize chest compression placement over the mid-LV, meriting further resuscitation research.
Background:
Standard CPR guidelines recommend chest compressions over the lower half of the sternum; however, this often results in compressions over the left ventricular outflow tract (LVOT) or proximal aorta, impeding blood flow. Improved outcomes have been noted when compressions are directed over the left ventricle.
Objective:
We evaluated whether transthoracic echocardiography (TTE) can accurately identify the mid-left ventricle (mid-LV) and whether this approach aligns more closely with the true mid-LV than the standard American Heart Association (AHA) compression location based on computed tomography (CT) of the chest.
Methods:
In this prospective observational study of adults undergoing chest CT, providers marked the AHA-recommended compression site and performed limited TTE to localize and mark the mid-LV. Radiopaque markers were placed at these locations and compared to CT-identified true mid-LV positions.
Results:
Among 65 patients, the mean distance from the AHA location to the true mid-LV based on chest CT was 74.2 mm. The distance from the ultrasound guided mid-LV marker to the true mid-LV was 64.6 mm. Ultrasound trained providers outperformed non-ultrasound trained providers in accuracy of localization. We found the AHA position to be cranial and medial to the true mid-LV. On CT, the most common structure beneath the AHA marker was the proximal ascending aorta (38.5%).
Conclusion:
TTE-guided localization of the mid-LV is feasible and more accurate than the standard AHA landmark, particularly when performed by trained providers. A TTE-guided approach to mid-LV localization may optimize location of chest compression over the mid-LV, warranting further evaluation in resuscitation settings.
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