Comparison of optimal point on the sternum for chest compression between obese and normal weight individuals with respect to body mass index, using computer tomography: A retrospective study

Lee, Juncheol; Oh, Jaehoon; Lim, Tae Ho; Kang, Hyunggoo; Park, Jung Hwan; Song, Soon Young; Shin, Ga Hye; Song, Yeongtak

doi:10.1016/j.resuscitation.2018.04.023

Cited by 28 publications

(19 citation statements)

References 30 publications

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“…2). 17) We estimated several parameters on the axial view that showed the midpoint of the lower half of the sternum in two groups: (1) external chest AP diameter (mm), from the skin on the sternum vertically to the skin on the back;…”

Section: Data Collectionmentioning

confidence: 99%

Comparison of Heart Proportions Compressed by Chest Compressions Between Geriatric and Nongeriatric Patients Using Mathematical Methods and Chest Computed Tomography: A Retrospective Study

Yoo

Lee

et al. 2018

Ann Geriatr Med Res

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Background Current guidelines recommended that chest compression depths during car-diopulmonary resuscitation (CPR) should be at least one-fifth of the external chest ante-riorposterior (AP) diameter. The chest AP diameter increases because of dorsal kyphosis, senile emphysema, and poor lung compliance associated with aging. This study aimed to compare the proportion of the heart compressed by chest compression (based on the ejection fraction [EF]) in geriatric and nongeriatric patients. Methods We performed a retrospective analysis of the chest computed tomography findings obtained between January 2010 and August 2016 and measured the chest anatomical parameters such as the perpendicular external and internal chest AP diameters with the heart AP diameter. Based on values of these parameters, EFs with 50- and 60-mm depths were obtained. In addition, we investigated and compared the proportion of 50- and 60-mm depths and heart AP to external chest AP diameter between the 2 groups. Results We randomly selected and analyzed 100 of 1,921 geriatric and 100 of 22,090 nongeriatric populations from a database. The means±standard deviations of EFs with 50- and 60-mm depths for geriatric and nongeriatric people were 37.1%±12.1% vs. 43.2%±13.8% and 47.5%±12.8% vs. 54.6%±14.8%, respectively (all p<0.001). The proportion of 50- and 60-mm depths and heart AP to external chest AP diameter were significantly different between the 2 groups (all p<0.05). Conclusion Chest compression depths based on current guidelines are not sufficient for geriatric patients during CPR; hence, deeper chest compressions would be considered.

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Section: Data Collectionmentioning

confidence: 99%

Comparison of Heart Proportions Compressed by Chest Compressions Between Geriatric and Nongeriatric Patients Using Mathematical Methods and Chest Computed Tomography: A Retrospective Study

Yoo

Lee

et al. 2018

Ann Geriatr Med Res

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“…They have shown that the optimal compression point was found 3 cm left of the origo [35]. It has also been suggested that in obese individuals the appropriate place of compressions may be higher than was indicated previously [36]. Summarising, the compression quality formula should not include this parameter.…”

Section: Discussionmentioning

confidence: 94%

Assessment of Chest Compression Quality — a systematic review

Kłosiewicz

Puslecki

Zalewski

et al. 2020

Disaster Emerg Med J

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INTRODUCTION: High-quality chest compression (CC) is a crucial factor that determines the survival of cardiac arrest patients. Adequate quality should be featured by appropriate compression rate and depth, and full chest recoil after each compression. The ranges are strictly determined in Resuscitation Guidelines. All these parameters are interdependent. Currently, there is a need to find or develop a universal index that will enable the definition and determination of the overall quality of CCs. MATERIAL AND METHODS: A systematic review of the MEDLINE, EMBASE, COCHRANE, and GOOGLE SCHOLAR databases was performed. The authors aimed to find papers in which the quality of CC was assessed. The extracted information included measurement of the CC quality in a direct and objective manner-by analysing the depth, rate, and recoil of CC, position of the hands, duty cycle, and indirectly by evaluating chest compression fraction (CCF). Papers describing the quality of CC based on a combination of various components of the CC quality were selected for analysis. RESULTS: In total 1604 publications were obtained. Among them, 21 articles satisfied the search criteria. In most of the papers, it was suggested that compressions should have been considered as correct when they met simultaneously all quality criteria. Only three papers presented any mathematical formula that could have been used for further comparisons. CONCLUSIONS: Although many proposals have been developed, no single, universal, and commonly accepted indicator of resuscitation quality has been so far designed and subsequently applied. Further work on this subject is warranted and strongly recommended.

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“…According to cardiac pump theory 38 , in order to provide high-quality chest compression, the rescuer's hands should be placed on the lower half of the sternum 39 where the maximal left ventricle diameter is assumed to be 40 . Lee et al 41 . evaluated the point of maximal left ventricular diameter by examining CT scans, which was noted to be more cranial in patients of obese than of normal weight.…”

Section: Anthropometric Parameters For Central Obesity Several Commomentioning

confidence: 99%

Associations between Central Obesity and Outcomes of Adult In-hospital Cardiac Arrest: A Retrospective Cohort Study

Wang

Chang

Tsai

et al. 2020

Sci Rep

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to investigate the association between central obesity and outcomes following in-hospital cardiac arrest (iHcA). A single-centred retrospective study was conducted. Adult patients that experienced IHCA during 2006-2015 were screened. Body mass index (BMI) was calculated at hospital admission. central obesity-related anthropometric parameters were measured by analysing computed tomography images. A total of 648 patients were included, with mean BMI of 23.0 kg/m 2. the proportions of BMI-defined obesity in this cohort were underweight (13.1%), normal weight (41.4%), overweight (31.5%) and obesity (14.0%). The mean waist circumference was 85.9 cm with mean waistto-height ratio (WHtR) of 0.53. The mean sagittal abdominal diameter was 21.2 cm with mean anterior and posterior abdominal subcutaneous adipose tissue (SAT) depths of 1.6 and 2.0 cm, respectively. Multivariate logistic regression analyses indicated BMI of 11.7-23.3 kg/m 2 (odds ratio [OR]: 2.53, 95% confidence interval [CI]: 1.10-5.85; p-value = 0.03), WHtR of 0.49-0.59 (OR: 3.45, 95% CI: 1.56-7.65; p-value = 0.002) and anterior abdominal SAT depth <1.9 cm (OR: 2.84, 95% CI: 1.05-7.74; p-value = 0.04) were positively associated with the favourable neurological outcome. Central obesity was associated with poor IHCA outcomes, after adjusting for the effects of BMI. Each year, approximately 209,000 American patients experience in-hospital cardiac arrest (IHCA) 1. About 24% of IHCA patients survive to hospital discharge; among them, 14% experience significant neurological disability 1. The prevalence of obesity has increased rapidly over the last few decades with 40% of the American population classified as obesity 2. Body mass index (BMI) has been demonstrated to be associated with IHCA outcomes 3,4. Jain et al 3. reported that for IHCA with shockable rhythms, patients with BMI < 18.5 kg/m 2 , BMI 18.5-24.9 kg/m 2 or BMI ≥ 35 kg/m 2 had lower survival rates compared with patients with BMI 25.0-29.9 kg/m 2 or BMI 30.0-34.9 kg/m2. However, for IHCA with non-shockable rhythms, patients with a moderately elevated BMI seemed to have better IHCA outcomes. This so-called "obesity paradox" was also observed in other cardiovascular diseases 5. However, using BMI as the sole obesity index does not consider body adipose distribution. In patients with coronary disease, Coutinho et al 6. noted that being overweight or obese per BMI criteria did not cause increased mortality in the absence of central obesity. When parameters defining central obesity were taken into account, the phenomenon of "obesity paradox" or "BMI paradox" was less obvious 6 .

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Comparison of optimal point on the sternum for chest compression between obese and normal weight individuals with respect to body mass index, using computer tomography: A retrospective study

Cited by 28 publications

References 30 publications

Comparison of Heart Proportions Compressed by Chest Compressions Between Geriatric and Nongeriatric Patients Using Mathematical Methods and Chest Computed Tomography: A Retrospective Study

Comparison of Heart Proportions Compressed by Chest Compressions Between Geriatric and Nongeriatric Patients Using Mathematical Methods and Chest Computed Tomography: A Retrospective Study

Assessment of Chest Compression Quality — a systematic review

Associations between Central Obesity and Outcomes of Adult In-hospital Cardiac Arrest: A Retrospective Cohort Study

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