Abstract 109: Evaluation of the Chest Compression Landmarks According to the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care by Using Computed Tomography Examinations for Infants
Purpose: To verify by computed tomography (CT) that the left ventricle (LV) is compressed and the abdomen avoided using the two-finger and the two-thumb techniques in infants as described in the 2010 American Heart Association (AHA) for cardiopulmonary resuscitation (CPR) guidelines.
Methods: Using chest CT examinations in 63 infant patients from March 2002 to July 2011, we retrospectively measured distances of inter-nipple line (INL) and lower third (LT) of the sternum from xiphoid process. Below the xiphoid process was regarded as abdomen. In addition, distances between LV maximal diameter (LVMD) and xiphoid processes were also measured to determine whether LVs were covered using the resuscitation techniques. These distances were compared with distances between the fingers and thumbs of 20 adults performing the two-finger and the two-thumb techniques on templates of infant’s chests.
Results: The mean distances of the INL and the LT of the sternum from the xiphoid process were 32 ± 8 mm (range, 14-52mm) and 12 ± 2 mm (range, 10-16mm), respectively. The LVMD was 15 ± 6 mm (range, 1-27mm) from the xiphoid process, which on average was 16 mm below the INL and 3 mm above from the LT of sternum, respectively. When apply the mean distances between the digits of adults performing the two-finger and two-thumb techniques of 28 ± 3 mm and 23 ± 5 mm, respectively, the LVMD was covered in 57 patients (90.5%) using the two-finger technique and in 59 patients (93.7%) using the two-thumb technique. The upper abdomen was compressed in 22 patients (34.9%) by the two-finger technique with a mean distance of 4.3 mm (range 1.7 - 10.8 mm) and in 16 patients (25.3%) by the two-thumb technique with a mean distance of 0.7 mm (range, 0.3 -1.8mm).
Conclusion: When applying 2010 AHA CPR guidelines for infants, the chest compression landmarks for two-finger and two-thumb techniques adequately cover the LV in more than 90% of patients. However, in 25-35% of infants, the upper abdomen is compressed from few millimeters to 11 millimeters.
- © 2012 by American Heart Association, Inc.