Proper compression landmark and depth for cardiopulmonary resuscitation in patients with pectus excavatum: a study using CT

Lee, Ki Hyun; Kim, Kun Woo; Kim, Eun Young; Kim, Hyung Sik; Kim, Jeong-Ho; Cho, Jin Seong; Yang, Hyuk Jun

doi:10.1136/emermed-2013-202671

Cited by 5 publications

(10 citation statements)

References 12 publications

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“…HI is defined as the ratio between transverse diameter of the chest and the shortest distance between the sternum and vertebrae [19]. The HI is measured at the deepest aspect of the thoracic curve, with a normal chest HI ratio calculated as 2 or less.…”

Section: Haller Indexmentioning

confidence: 99%

“…Only a few published papers reported on selection criteria for determining the magnitude of dosimetric benefit the DIBH technique offers individual patients [8]. This is especially important for patients with unfavorable chest wall shape (i.e., variations of pectus excavatum or pectus carinatum) [18,19]. Furthermore, patient selection for the DIBH technique varies across the literature from consultation to post-planning evaluation.…”

Section: Introductionmentioning

confidence: 99%

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A Retrospective Dosimetric Study of Radiotherapy Patients with Left-Sided Breast Cancer; Patient Selection Criteria for Deep Inspiration Breath Hold Technique

Dell’Oro

Giles

Sharkey³

et al. 2019

Cancers

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Background: Several studies have investigated cardiac dose reduction when utilizing the deep inspiration breath hold (DIBH) technique in patients undergoing radiotherapy for left-sided breast cancer. This paper aims to recommend potential selection criteria based on a retrospective single institute study of free breathing (FB) and DIBH computed tomography (CT) simulation planning scans. Methods: Dosimetric comparisons were performed retrospectively for 20 patients correlating the dose reduction and patient anatomical factors (anatomical variation of chest shape, chest wall separation, total lung volume (TLV) and others). Results: Paired t-tests demonstrated significant cardiac dose reduction for most patients but not all. Minimal cardiac dose reduction was observed for three patients using their DIBH plan, with one patient receiving a higher dose. Linear regression analysis identified a positive correlation between the patient’s TLV (on the FB CT simulation scan) and the magnitude of dosimetric benefit received (0.4045 R2). Conclusion: The TLV measured on a FB plan could potentially be utilised to predict cardiac exposure and assist with patient selection for DIBH. This is important in resource allocation, as DIBH may be unnecessarily recommended for some patients with little dosimetric benefit.

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Section: Haller Indexmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Retrospective Dosimetric Study of Radiotherapy Patients with Left-Sided Breast Cancer; Patient Selection Criteria for Deep Inspiration Breath Hold Technique

Dell’Oro

Giles

Sharkey³

et al. 2019

Cancers

View full text Add to dashboard Cite

show abstract

“…5 The authors showed that displacement of the heart to the left was significantly greater in PE patients, with mean difference of 11 mm compared with controls, and that the left ventricle was located in all PE patients at the level of lower half of the sternum; they suggested this landmark is appropriate for CPR in PE patients. They defined the external thickness of the chest as the distance between the anterior and posterior skin margin and the internal thickness as the distance between the posterior sternum and anterior vertebrae.…”

Section: Sirmentioning

confidence: 96%

Cardiopulmonary resuscitation in pectus excavatum patients: Is it time to say more?

2015

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“…Abnormal growth of the sternum and ribs results in a concave appearance of the anterior chest wall. The posteriorly depressed sternum compresses and displaces the heart and lungs 2‐5 . Patients with pectus excavatum frequently complain of cardiopulmonary symptoms such as dyspnea, tachycardia, and exercise intolerance 2 due to decreased pulmonary function 2,6 and cardiac abnormalities 4,6‐8 .…”

Section: Introductionmentioning

confidence: 99%

“…In a recent retrospective study, computed tomography was used to determine the optimal compression site and depth during CPR in adult patients with pectus excavatum 5 . The authors showed that the heart was displaced more leftward in patients with pectus excavatum than in the normal population (mean difference, 11 mm) but mentioned that the lower half of the sternum was the appropriate compression site for CPR.…”

Section: Introductionmentioning

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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Proper compression landmark and depth for cardiopulmonary resuscitation in patients with pectus excavatum: a study using CT

Cited by 5 publications

References 12 publications

A Retrospective Dosimetric Study of Radiotherapy Patients with Left-Sided Breast Cancer; Patient Selection Criteria for Deep Inspiration Breath Hold Technique

A Retrospective Dosimetric Study of Radiotherapy Patients with Left-Sided Breast Cancer; Patient Selection Criteria for Deep Inspiration Breath Hold Technique

Cardiopulmonary resuscitation in pectus excavatum patients: Is it time to say more?

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

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