Summary
Background
Despite the new release of CPR guidelines, there was insufficient evidence for or
against a specific hand position for manual chest compression in adults. Computed
tomography (CT) images of the chest can demonstrate objectively the spatial relationship
between the surface landmarks on the chest and the inner viscera underneath them.
This study is designed to examine the spatial relationship between the inter-nipple
line (INL) and the heart in order to determine the proper hand position for more effective
CPR.
Methods
We enrolled 189 adult patients who underwent low dose chest CT from 16 October to
10 November 2006. Patients’ demographic data were collected. The sternal length, the
distance from the xiphoid to the INL, and the distance from the xiphoid to the maximal
heart diameter were measured by using 3D reconstructed CT images.
Results
In about 80% of the 189 patients’ CT images, the intrathoracic structure just underneath
the INL was the ascending aorta (18.0%), the root of aorta (48.7%), or the left ventricular
outflow tract (12.7%), rather than the left ventricle itself (20.6%). The INL was
6.2 ± 1.8 cm and 5.6 ± 1.9 cm cephalad to the xiphoid for the male and the female, respectively. The coronal
CT image plane of the maximal heart diameter was 2.8 ± 1.6 cm and 2.3 ± 1.6 cm cephalad to the xiphoid for the male and the female, respectively.
Conclusion
For more efficient and effective chest compression during CPR, compressing the sternum
more caudally than the INL could be considered if it is not associated with the risk
of increasing internal visceral injuries.
Keywords
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Article info
Publication history
Published online: June 22, 2007
Accepted:
May 1,
2007
Received in revised form:
April 30,
2007
Received:
March 23,
2007
Footnotes
☆A Spanish translated version of the summary of this article appears as Appendix in the online version at 10.1016/j.resuscitation.2007.05.003.
Identification
Copyright
© 2007 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
