Resuscitation
Volume 81, Issue 5 , Pages 544-548, May 2010

Evaluation of the Neonatal Resuscitation Program's recommended chest compression depth using computerized tomography imaging

  • Andrew Meyer

      Affiliations

    • Children's Hospital of Philadelphia, Department of Neonatology, United States
    • Corresponding Author InformationCorresponding author at: Crozer-Chester Medical Center, Neonatology, One Medical Center Blvd., Upland, PA 19013, United States. Tel.: +1 610 724 8066.
  • ,
  • Vinay Nadkarni

      Affiliations

    • The Children's Hospital of Philadelphia, Department of Anesthesia, Critical Care Medicine, and Pediatrics, University of Pennsylvania School of Medicine, United States
  • ,
  • Avrum Pollock

      Affiliations

    • Children's Hospital of Philadelphia, Department of Radiology, United States
  • ,
  • Charles Babbs

      Affiliations

    • Purdue University, Department of Biomedical Engineering, United States
  • ,
  • Akira Nishisaki

      Affiliations

    • The Children's Hospital of Philadelphia, Department of Anesthesia, Critical Care Medicine, and Pediatrics, University of Pennsylvania School of Medicine, United States
    • Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, United States
  • ,
  • Matthew Braga

      Affiliations

    • Children's Hospital at Dartmouth, Department of Pediatric Critical Care, United States
  • ,
  • Robert A. Berg

      Affiliations

    • The Children's Hospital of Philadelphia, Department of Anesthesia, Critical Care Medicine, and Pediatrics, University of Pennsylvania School of Medicine, United States
  • ,
  • Anne Ades

      Affiliations

    • Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, United States

Received 14 July 2009; received in revised form 23 December 2009; accepted 29 January 2010. published online 11 March 2010.

Abstract 

Background

Neonatal Resuscitation Program (NRP) guidelines recommend chest compression depths of 1/3 the anterior–posterior (AP) chest depth. Appropriateness of this recommendation has not been rigorously assessed.

Objective

To compare the efficacy and safety of neonatal chest compression depths of 1/4, 1/3, and 1/2 AP chest depth during cardiopulmonary resuscitation.

Design/methods

Anterior–posterior internal and external chest depth, heart dimensions, and non-cardiac thoracic tissue depth were measured from neonatal chest CTs. Using these measurements, residual internal chest depth, the remaining depth of the chest between the sternum and spine after external compression, was calculated for compression depths of 1/4, 1/3 and 1/2 anterior–posterior chest depth. Compression sufficient to compress the chest to <10mm of residual internal chest depth was defined as over-compression. Using a mathematic model, an estimated ejection fraction (EF) was calculated for each chest compression depth. Compression inadequate to obtain a predicted 50% EF was defined as under-compression. Descriptive statistics, Fisher's exact test and Student's t-test were used to analyze data, where appropriate.

Results

Fifty-four neonatal chest CT scans were evaluated. Estimated chest compression induced EF increased incrementally with increasing chest compression depth (EF was 51±3% with 1/4 AP chest depth vs 69±3% with 1/3 AP chest depth, and 106% with 1/2 AP chest depth, p<0.001). Under-compression was predicted in 29/54 patients with 1/4 AP compression depth, but none of the patients with 1/3 or 1/2 AP compression depth, p<0.001. Over-compression, or lack of adequate residual chest depth, was predicted in 49/54 patients with 1/2 AP compression depth, but none of the patients with 1/4 or 1/3 AP compression depth, p<0.001.

Conclusions

Mathematical modeling based upon neonatal chest CT scan dimensions suggests that current NRP chest compression recommendations of 1/3 AP chest depth should be more effective than 1/4 compression depth, and safer than 1/2 AP compression depth.

Abbreviations: AHA, American Heart Association, AP, anterior–posterior, CPR, cardiopulmonary resuscitation, CT, computerized tomography, EF, ejection fraction, NRP, Neonatal Resuscitation Program, PALS, pediatric advanced life support

Keywords: Neonatal resuscitation, NRP, Chest compressions

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.01.032.

PII: S0300-9572(10)00083-3

doi:10.1016/j.resuscitation.2010.01.032

Resuscitation
Volume 81, Issue 5 , Pages 544-548, May 2010