The Maximum Diameter of the Left Ventricle May Not Be the Optimum Target for Chest Compression During Cardiopulmonary Resuscitation: A Preliminary, Observational Study Challenging the Traditional Assumption

Park, Gwang-Yeol; Oh, Won Sup; Chon, Sung-Bin; Kim, Shinwoo

doi:10.1053/j.jvca.2019.07.005

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…The compression to this point can lead to the increased stroke volume and coronary perfusion, resulting in successful return of spontaneous circulation (ROSC) and good outcome. Chest radiography [2][3][4] and computed tomography 5 have been used in order to estimate or locate the point of maximum LV diameter. Cho et al recently estimated the position of maximum LV diameter using posteroanterior chest radiography and compared with personalized optimum chest compression point on computed tomography.…”

Section: Commentmentioning

confidence: 99%

“…Furthermore, contrary to the traditional theory, the point of maximal LV diameter may not be optimal for chest compression. Patients with point of maximal LV diameter located at close to the mid-sternum have not shown better ROSC or survival-to -discharge rate 4. Kim et al analyzed computed tomography images and suggested that the optimal chest compression position might be located rightwards to the maximum diameter of the right ventricle, rather than the traditional position identifying as the maximum diameter of the LV 5…”

Section: Commentmentioning

confidence: 99%

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Hand Placement During Chest Compressions in Parturients: A Pilot Study to Identify the Location of the Left Ventricle Using Transthoracic Echocardiography

Delgado¹,

Dawson²,

Schwaegler³

et al. 2021

Obstetric Anesthesia Digest

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Hand Placement During Chest Compressions in Parturients: A Pilot Study to Identify the Location of the Left Ventricle Using Transthoracic Echocardiography

Delgado¹,

Dawson²,

Schwaegler³

et al. 2021

Obstetric Anesthesia Digest

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show abstract

Optimum chest compression point might be located rightwards to the maximum diameter of the right ventricle: A preliminary, retrospective observational study

Kim

Chon

Yoo

et al. 2020

Acta Anaesthesiol Scand

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BackgroundSome researchers have reported that applying compression closer to the maximum diameter of the left ventricle (Point_max.LV) is associated with worse clinical outcomes, challenging its traditional position as optimum compression point (Point_optimum). By locating the mid‐sternum (the actual compression site) in terms of Point_max.LV and its right ventricular equivalent (Point_max.RV), we aimed to determine its optimum horizontal position associated with increased chances of return of spontaneous circulation (ROSC).MethodsA retrospective, cross‐sectional study was performed at a university hospital from 2014 to 2019 on non‐traumatic out‐of‐hospital cardiac arrest (OHCA) victims who underwent chest computed tomography. On absolute x‐axis, we designated the x‐coordinate of the mid‐sternum (x_mid‐sternum) as 0 and leftward direction as positive. Re‐defining the x‐coordinate of Point_max.RV and Point_max.LV as 0 and 1 interventricular unit (IVU), respectively, we could convert x_mid‐sternum to “−x_max.RV/(x_max.LV − x_max.RV) (IVU).” Using multiple logistic regression analysis, we investigated whether this converted x_mid‐sternum was associated with clinical outcomes, adjusting core elements of the Utstein template.ResultsAmong 887 non‐traumatic OHCA victims, 124 [64.4 ± 16.7 years, 43 women (34.7%)] were enrolled. Of these, 80 (64.5%) exhibited ROSC. X_mid‐sternum ranging from −1.71 to 0.58 (−0.36 ± 0.38) IVU was categorised into quintiles: <−0.60, −0.60 to −0.37, −0.37 to −0.22, −0.22 to −0.07 and ≥−0.07 (reference) IVU. The first quintile was positively associated with ROSC (odds ratio [95% confidence interval], 9.43 [1.44, 63.3]).ConclusionPoint_optimum might be located far rightwards to Point_max.RV, challenging the traditional assumption identifying Point_optimum as Point_max.LV.

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Influence of bystander activation on pre-hospital emergency care response time: systematic review

Musyoka,

Tenambergen,

Mapesa

et al. 2023

Emerg Care J

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This article presents a systematic review and analysis of grey literature to identify and address gaps in knowledge regarding the role and influence of bystander activation on pre-hospital emergency care (PEC) response time. We conducted a systematic search for full-text articles published since 2000 in Web of Science, PubMed, Science Direct, and Google Scholar databases. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using “pre-hospital emergency care response time” and “bystanders” as search keywords. The risk of bias was assessed using the ROBINS-I tool. Our analysis included forty-six relevant studies meeting the inclusion criteria. However, we observed that many studies were poorly reported, posing risks of selection and detection biases. Additionally, we identified methodological and study design weaknesses in five studies. Given the critical role of PEC services in saving lives and preventing medical complications, the timely provision of these services is paramount. Bystanders play a central role in activating emergency medical services (EMS) and providing cardiopulmonary resuscitation. Prompt calls to EMS by bystanders resulted in reduced PEC response times, improved survival chances, and better neurological outcomes, particularly among out-of-hospital cardiac arrest patients. There is substantial evidence that prompt bystander activation of EMS significantly reduces PEC response times, thereby saving lives and strengthening existing PEC systems. However, further research is necessary to accurately assess the impact of different interventions aimed at enhancing bystander activation of EMS and reducing PEC response times.

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The Maximum Diameter of the Left Ventricle May Not Be the Optimum Target for Chest Compression During Cardiopulmonary Resuscitation: A Preliminary, Observational Study Challenging the Traditional Assumption

Cited by 3 publications

References 22 publications

Hand Placement During Chest Compressions in Parturients: A Pilot Study to Identify the Location of the Left Ventricle Using Transthoracic Echocardiography

Hand Placement During Chest Compressions in Parturients: A Pilot Study to Identify the Location of the Left Ventricle Using Transthoracic Echocardiography

Optimum chest compression point might be located rightwards to the maximum diameter of the right ventricle: A preliminary, retrospective observational study

Influence of bystander activation on pre-hospital emergency care response time: systematic review

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