Optimal Chest Compression Position for Patients With a Single Ventricle During Cardiopulmonary Resuscitation*

Park, Jung‐Bin; Song, In Kyung; Lee, Ji Hyun; Kim, Eun Hee; Kim, Hee Soo; Kim, Jin Tae

doi:10.1097/pcc.0000000000000658

Cited by 11 publications

(13 citation statements)

References 16 publications

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“…33À39 There are important differences in anatomy between individuals and depend on age, body mass index, congenital cardiac disease and pregnancy, and thus one specific hand placement strategy might not provide optimal compressions across a range of persons. 34,38,40 These findings led ILCOR to retain their current recommendation and continue to suggest performing chest compressions on the lower half of the sternum in adults in cardiac arrest (weak recommendation, very-low-certainty evidence). Consistent with the ILCOR treatment recommendations, the ERC recommends teaching that chest compressions should be delivered 'in the centre of the chest', whilst demonstrating hand position on the lower half of the sternum.…”

Section: Hand Position During Compressionsmentioning

confidence: 99%

European Resuscitation Council Guidelines 2021: Basic Life Support

Semeraro²,

et al. 2021

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The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), CPR quality measurement, new technologies, safety, and foreign body airway obstruction.

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Section: Hand Position During Compressionsmentioning

confidence: 99%

European Resuscitation Council Guidelines 2021: Basic Life Support

Semeraro²,

et al. 2021

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“…Children with congenital heart disease have less myocardial reserves, are compromised hemodynamically, and are associated with complex physiologic and technical management issues. 19,20 It is also unknown from the current literature if the management of cardiac arrest is different among children with univentricular and biventricular physiology. In a recent study, Park and colleagues 19 suggested that the optimal chest compression level for patients with a single ventricle is lower than that suggested in the current guidelines for the normal population.…”

Section: Congenital: Perioperative Managementmentioning

confidence: 99%

Characterizing cardiac arrest in children undergoing cardiac surgery: A single-center study

Gupta

Wilcox

Noel

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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“…Therefore, the ventricles should be compressed as much as possible to generate forward blood flow and the effectiveness of the cardiac pump mechanism relies on the compression site 22 . However, optimal hand position during chest compression may differ with age, 23 patient positions, 24 cardiac anomalies, 25 and chest wall deformities 5 …”

Section: Discussionmentioning

confidence: 99%

“…First, because this was a retrospective review of chest computed tomography images, forward flow generation during real CPR in pediatric patients with pectus excavatum was not studied. Instead, we hypothesized that compression at the level of the largest cross‐sectional area of the ventricles would generate maximum forward blood flow based on the cardiac pump theory 5,18,23‐25 . Additionally, the incidence of chest compression‐related complications remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary resuscitation in pediatric pectus excavatum patients—Where is the heart?

Jang

Park

Kang

et al. 2020

Pediatric Anesthesia

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Background In children with pectus excavatum, the posteriorly depressed sternum compresses and displaces the heart. However, the currently recommended compression site and depth for cardiopulmonary resuscitation have not been studied in this population. Aim This retrospective study investigated the location of the center of ventricles with the largest cross‐sectional area to determine the optimal site and depth for chest compressions in pediatric pectus excavatum patients. Methods Chest computed tomography images of 94 pediatric pectus excavatum patients before and after correction surgery were compared with normal patients. The caudal displacement of the ventricles was calculated by dividing the length of sternum by the length from the suprasternal notch to the transverse level of the largest cross‐sectional area of the ventricles. The proportional leftward deviation of the center of the ventricles from the midline versus transverse diameter of the thorax was calculated. The remaining internal thickness was calculated at the midline assuming the recommended compression depth of one‐third of the anterior to posterior diameter. Results Compared with the normal population (mean = 81% [SD = 10.3%]), pediatric pectus excavatum patients showed caudal displacement of ventricles before (98.2% [15.1%], 95% CI of mean difference; 13.7%‐20.5%, P < .001) and after correction (100.4% [13.5%], 95% CI of mean difference; 16.2%‐22.5%, P < .001). Compared with the normal population (6.9% [2.7%]), pediatric pectus excavatum patients showed leftward deviation of ventricles before (16.2% [5.5%], 95% CI of mean difference; 8.2%‐10.4%, P < .001) and after correction (13.3% [4.8%], 95% CI of mean difference; 5.3%‐7.3%, P < .001). The remaining internal thickness assuming the recommended chest compression was <10 mm in 54/94(57.4%) and 18/94 (19.1%) of pediatric pectus excavatum patients before and after correction, respectively. Conclusions Pediatric pectus excavatum patients showed significant caudal displacement and leftward deviation of the ventricles compared with the normal population despite correction surgery and the currently recommended compression site and depth might injure intrathoracic structures without effective cardiac compression during cardiopulmonary resuscitation.

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Optimal Chest Compression Position for Patients With a Single Ventricle During Cardiopulmonary Resuscitation*

Abstract: The optimal compression position in patients with a single ventricle is approximately 5-25% of the lower sternum. The optimal compression level for patients with a single ventricle is lower than that suggested in current guidelines for the normal population.

Cited by 11 publications

References 16 publications

European Resuscitation Council Guidelines 2021: Basic Life Support

European Resuscitation Council Guidelines 2021: Basic Life Support

Characterizing cardiac arrest in children undergoing cardiac surgery: A single-center study

Cardiopulmonary resuscitation in pediatric pectus excavatum patients—Where is the heart?

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