Theoretical personalized optimum chest compression point can be determined using posteroanterior chest radiography

Cho, Sunho; Oh, Won Sup; Chon, Sung-Bin; Kim, Shinwoo; Hwang, Keunha

doi:10.1016/j.resuscitation.2018.05.007

Cited by 9 publications

(18 citation statements)

References 29 publications

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“…[15][16][17] In this study, we aimed to derive and validate the rules to determine personalized P_max.LV using the chest AP. We used the same methods as Cho et al 12 except we used chest_AP instead of chest_PA. First, we identified the 3D coordinates of P_max.LV on computed tomography (CT) which is the reference standard test.…”

Section: What Is New In the Current Studymentioning

confidence: 99%

“…Cases with the following thoracic abnormalities were included as they were found not to affect the rules in the determination of P_max.LV in the previous study: > 2-cm depth pleural effusion, > 1-cm depth hemo-/ pneumothorax, a destroyed lung, lobectomy, atelectasis, hiatal hernia, > 5-mm depth pericardial effusion, pericardial tumor/cyst, thoracic aorta dissection/aneurysm, and widened mediastinum. 12 We assigned enrolled cases randomly to derivation and validation sets using a 3:2 ratio, respectively. .…”

Section: Design Setting and Participantsmentioning

confidence: 99%

“…Additionally, it was suggested that it would be important to determine 'personalized P_ max.LV' using posteroanterior chest radiography (chest_PA), as patients suffering from myocardial infarction are considered for personalized therapy. [12][13][14] Assuming that the relative location of P_max.LV within the heart would be constant universally, we mathematically derived and validated rules to locate P_max.LV using simple parameters measured on chest_PA, including cardiac diameter, right cardiac border, and cardiac height (Fig. 1A).…”

Section: Introductionmentioning

confidence: 99%

“…1A). 12 To apply the rules without the interruption of CPR, chest_PA should be performed before the cardiac arrest (CA). Due to the lack of previously investigated chest_PAs, these rules are applicable to only 71% and 38% of in-hospital CA (IHCA) and out-ofhospital CA (OHCA) victims, respectively.…”

Section: Introductionmentioning

confidence: 99%

“…Due to the lack of previously investigated chest_PAs, these rules are applicable to only 71% and 38% of in-hospital CA (IHCA) and out-ofhospital CA (OHCA) victims, respectively. 12 This limited applicability might have reached up to 100% and 60%, respectively, if P_ max.LV had been estimated using anteroposterior chest radiography (chest_AP). Chest_PA requires patients to stand up alone and take a deep breath; critically ill patients who are unable to do this are required to undergo portable chest_AP instead.…”

Section: Introductionmentioning

confidence: 99%

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Determination of the theoretical personalized optimum chest compression point using anteroposterior chest radiography

Kim

Chon

et al. 2019

Clin Exp Emerg Med

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Objective There is a traditional assumption that to maximize stroke volume, the point beneath which the left ventricle (LV) is at its maximum diameter (P_max.LV) should be compressed. Thus, we aimed to derive and validate rules to estimate P_max.LV using anteroposterior chest radiography (chest_AP), which is performed for critically ill patients urgently needing determination of their personalized P_max.LV. Methods A retrospective, cross-sectional study was performed with non-cardiac arrest adults who underwent chest_AP within 1 hour of computed tomography (derivation:validation = 3:2). On chest_AP, we defined cardiac diameter (CD), distance from right cardiac border to midline (RB), and cardiac height (CH) from the carina to the uppermost point of left hemi-diaphragm. Setting point zero (0, 0) at the midpoint of the xiphisternal joint and designating leftward and upward directions as positive on x-and y-axes, we located P_max.LV (x_max.LV, y_max.LV). The coefficients of the following mathematically inferred rules were sought: x_max.LV = α0*CD-RB; y_max.LV = β0*CH+γ0 (α0: mean of [x_max.LV+RB]/CD; β0, γ0: representative coefficient and constant of linear regression model, respectively). Results Among 360 cases (52.0 ± 18.3 years, 102 females), we derived: x_max.LV = 0.643*CD-RB and y_max.LV = 55-0.390*CH. This estimated P_max.LV (19 ± 11 mm) was as close as the averaged P_max.LV (19 ± 11 mm, P = 0.13) and closer than the three equidistant points representing the current guidelines (67± 13, 56± 10, and 77± 17 mm; all P < 0.001) to the reference identified on computed tomography. Thus, our findings were validated. Conclusion Personalized P_max.LV can be estimated using chest_AP. Further studies with actual cardiac arrest victims are needed to verify the safety and effectiveness of the rule.

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