Verification of the Optimal Chest Compression Depth for Children in the 2015 American Heart Association Guidelines: Computed Tomography Study

Kim, Yong Hwan; Lee, Jun Ho; Cho, Kwang Won; Lee, Dong Woo; Kang, Mun Ju; Lee, Kyoung Yul; Byun, Joung Hun; Lee, Young Hwan; Hwang, Seong Youn; Lee, Na Kyoung

doi:10.1097/pcc.0000000000001369

Cited by 9 publications

(7 citation statements)

References 16 publications

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“… Three local radiological studies N = 442, N = 349, N = 203) which suggest that ∼ 4 cm and ∼ 5 cm were too deep in infants and children respectively. 22 , 23 , 24 Chest compression: ventilation ratio Layperson: − 1 rescuer: 30:2 − 2 rescuers: 15:2 Healthcare worker: − 1-rescuer- 30:2 − 2 or more rescuers: 15:2 Adolescents with pubertal signs- 30:2 Layperson: − 30:2 Healthcare worker: − 1-rescuer- 30:2 − 2 or more rescuers: 15:2 Adolescents with pubertal signs- 30:2 Layperson: − 30:2 Healthcare worker: − 1-rescuer- 30:2 − 2 or more rescuers: 15:2 >12 years old: 30:2 Layperson: − 1 rescuer: 30:2 − 2 rescuers: 15:2 Healthcare worker: − 1-rescuer- 30:2 − 2 or more rescuers: 15:2 ≥8 years old: 30:2 Changes from previous guidelines in 2015/2016 Nil change Nil change Nil change Nil change Values and preferences No new evidence or considerations to inform change No new evidence or considerations to inform change No new evidence or considerations to inform change No new evidence or considerations to inform change Chest compression rate 100 – 120/min Changes from previous guidelines in 2015/2016 Nil change Nil change Nil change Nil change Values and preferences No new evidence or considerations to inform change No new evidence or considerations to inform change No new evidence or considerations to inform change No new evidence or considerations to inform change AED use: age-group Infants and children < 8 years: attenuation pads 8 years or more: standard pads Infants and children < 1st grade: attenuation pads 1st grade (school child) or more: standard pads Neonates: Manual defibrillation only. AEDs not recommended.…”

Section: Resultsmentioning

confidence: 99%

“… 3 The three RCA member councils with their own published paediatric life support guidelines had local non-clinical (radiological and forensic) paediatric studies that supported shallower paediatric chest compression depth targets than those recommended by AHA, especially for infants and younger children. 20 , 21 , 22 , 23 , 24 AHA’s paediatric absolute chest compression depth targets were informed by two small, retrospective observational studies. 3 , 25 , 26 , 27 Thus, considerations of these may have contributed to the differences paediatric in chest compression depth targets between and across these guidelines.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of paediatric basic life support guidelines endorsed by member councils of Resuscitation Council of Asia

Ong,

Kurosawa,

Ikeyama

et al. 2023

Resuscitation Plus

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of paediatric basic life support guidelines endorsed by member councils of Resuscitation Council of Asia

Ong,

Kurosawa,

Ikeyama

et al. 2023

Resuscitation Plus

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“…Demographics and measured variables according to age group. Of the 531 paediatric patients who underwent chest CT scans during the study period, 25 with pectus excavatum (15), pigeon chest (1), other chest deformities (2), poor CT image (2), large amount of subcutaneous emphysema (3), and skin inflammation around the study landmark (2) were excluded. Of the 506 included patients, 298 (58.9%) were men.…”

Section: Resultsmentioning

confidence: 99%

“…However, a CC that is too deep might lead to patient injury; therefore, balancing these factors is important to achieve the best outcome [11][12][13] . The 2015 AHA guidelines introduced an upper limit of CC depth for adults, beyond which the outcomes could be adverse 14,15 . In our study, CC depths beyond the space between the two landmarks were either too shallow or too deep.…”

Section: Discussionmentioning

confidence: 99%

“…A feedback device may be easy to use when the absolute value of compression depth is applied, such as '4 cm for infant and 5 cm for children as indicated in the AHA guidelines' 1 . However, the absolute value of the compression depth applied for children may be too deep for younger children 13,15,18 . Therefore, the inherent physiologic landmark can be utilised.…”

Section: Discussionmentioning

confidence: 99%

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Applicability of Anatomical Landmarks for Chest Compression Depth in Cardiopulmonary Resuscitation for Children

Kim

Lee

et al. 2020

Sci Rep

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We evaluated the applicability of the neck and sternal notch (Sn) as anatomical landmarks for paediatric chest compression (cc) depth using chest computed tomography. the external anteroposterior diameter (eApD) of the neck and chest at the Sn level, mid-point between two landmarks (midlandmark), and eApD of the chest at the lower half of the sternum (eDLH) were measured. to estimate the depths of the landmarks from a virtual point at the same height as the position for cc, we calculated the differences between the EAPDs of the neck, SN, mid-landmark, and EDLH. We analysed the relationship between the depths of the landmarks and one-third eDLH using Bland-Altman plots. In all, 506 paediatric patients aged 1-9 years were enrolled. The depths of the neck, SN, and midlandmark were 53.7 ± 10.0, 37.8 ± 8.5, and 45.8 ± 9.0 mm, respectively. The mean one-third EDLH was 46.8 ± 7.0 mm. The means of the differences between the depths of the neck and one-third EDLH, depths of the SN and one-third EDLH, and depths of the mid-landmark and one-third EDLH were 9.0, −6.9, and 1.0 mm, respectively. The SN and neck are inappropriate landmarks to guide compression depth in paediatric cpR. Current cardiopulmonary resuscitation (CPR) guidelines emphasise the importance of chest compressions (CCs). CCs are important not only for adults but also for infants and children, who have relatively high rates of respiratory arrest 1. The American Heart Association (AHA) and European Resuscitation Council (ERC) recommends a CC depth of at least one-third of the chest anteroposterior (AP) dimension in children 1,2. Given the characteristics of children whose body sizes vary greatly with age, different CC depths may be required for them during CPR. Because of this variability, it may be difficult to meet the recommended criterion for fractional CC depths in actual child CPR situations. In line with these concerns, a previous study observed that the target CC depth recommended by the guidelines was not achieved in 81% of CPR events 3. Identifying an anatomical landmark close to one-third of the child's chest dimension may increase the probability of achieving the target CC depth during CPR. However, studies on anatomical landmarks of CC depth are limited. In a recent study using chest computed tomography (CT) in adults, Kim et al. reported that the suprasternal notch could be an anatomical landmark corresponding to one-fourth of the AP diameter of the chest 4. However, in that study, one-fourth was less than one-third fractional CC depth recommended for children. Additionally, the thorax grows and develops from birth to adolescence. The ratio of the vertical diameter to the transverse diameter of the chest varies from approximately 1:1 in infants to approximately 1:1.5 in adults 5. Considering the difference in the aspect ratio between adults and children, the landmark for CC depth in children is likely to be deeper than the sternal notch, which is the landmark identified in adults. In this context, we present the neck as a landmark for CC depth f...

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Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

Voorde

Turner

Djakow

et al. 2021

Notfall Rettungsmed

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Die Leitlinien des European Resuscitation Council (ERC) zu den lebensrettenden Maßnahmen bei Kindern (Paediatric Life Support, PLS) basieren auf dem 2020 verfassten „International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations“ der ILCOR (International Liaison Committee on Resuscitation). Dieses Kapitel beinhaltet Leitlinien zur Behandlung kritisch kranker oder verletzter Säuglinge, von Kindern und Jugendlichen vor, während und nach einem Atem-Kreislauf-Stillstand.

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Verification of the Optimal Chest Compression Depth for Children in the 2015 American Heart Association Guidelines: Computed Tomography Study

Cited by 9 publications

References 16 publications

Comparison of paediatric basic life support guidelines endorsed by member councils of Resuscitation Council of Asia

Comparison of paediatric basic life support guidelines endorsed by member councils of Resuscitation Council of Asia

Applicability of Anatomical Landmarks for Chest Compression Depth in Cardiopulmonary Resuscitation for Children

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

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