The need for a leftward shift in the flow-depth relationship during cardiopulmonary resuscitation

The uniform chest compression depth of 50 mm or greater recommended by current guidelines is not appropriate for all adults

“…Recently, the aortic pump theory, that is, that direct chest compression is predominantly directed at the aorta during adult resuscitation, was introduced by the analysis of CT images [18][19][20]. However, the mechanism of forward blood flow during CPR remains controversial, and there have been many debates on the role of the heart during CPR.…”

What Is the Correct Depth of Chest Compression for Infants and Children? A Radiological Study

“…This finding was different from previous research in adults in which compressions at either the lower half of the sternum or the internipple line led to compressions on the aorta rather than the heart. 14,15,28 The difference may stem from a relatively larger heart silhouette in the thoracic cavity in pediatric patients in comparison with adults. The left ventricle was rarely the target anatomical structure during adult chest compression, whereas a previous study 15 revealed that the left ventricle is directly beneath the midpoint of the lower half of the sternum in only 3% of adults.…”

“…Analysis of computed tomography (CT) images has indicated that direct chest compression is predominantly directed at the aorta during adult resuscitation. 14,15 All of the previous theories about the mechanisms of action have been focused on cardiac compression in the adult population.…”

Magical manoeuvre

“…Andrew’s manoeuvre appears to be an effective solution that could be used during the training of female rescuers, who are frequently unable to achieve sufficient CC depth compared with male rescuers 1 , 3 , 4 , 11 – 15 . Interestingly, it has been proven that the average rescuer is female 16 , 17 and the average arrest victim is male 11 , 18 – 20 .…”

“…Andrew’s manoeuvre appears to be an effective solution that could be used during the training of female rescuers, who are frequently unable to achieve sufficient CC depth compared with male rescuers 1 , 3 , 4 , 11 – 15 . Interestingly, it has been proven that the average rescuer is female 16 , 17 and the average arrest victim is male 11 , 18 – 20 . Furthermore, some authors have suggested that the average rescuer can achieve adequate compression depth in a significant majority of women, but in only a relatively small percentage of men 11 ; however, men represent the majority of all out-of-hospital arrest victims 5 , 11 , 21 .…”