Estimation of optimal CPR chest compression depth in children by using computer tomography.
OBJECTIVE
Pediatric consensus-driven cardiopulmonary resuscitation guidelines target chest compression (CC) depths of one third to one half anterior-posterior (AP) chest depth. Estimates for this target as assessed by computed tomography (CT) measurements of internal and external AP chest dimensions could direct future pediatric cardiopulmonary resuscitation guidelines.


METHODS
A total of 280 consecutive chest CT scans in permuted blocks of 20 for each of 14 age divisions between 0 and 8 years were reconstructed and analyzed. External and internal AP depths were measured at midsternum, and residual chest depth was calculated at simulated one-third and one-half AP compressions.


RESULTS
After a simulated compression calculation, one-half external AP depth CC would result in residual internal depth of <10 mm for 94% (263 of 280) of children 3 months to 8 years. For a one-third external AP CC, only 0.4% (1 of 280) of children 3 months to 8 years had a calculated residual internal chest depth <10 mm.


CONCLUSIONS
By using CT reconstruction estimates of chest dimensions across the developmental spectrum from 0 to 8 years of age, we demonstrated that a simulated CC targeting approximately one-third external AP chest depth seems radiographically appropriate for children aged 3 months to 8 years, whereas simulated CC targeting approximately one-half external AP chest depth seems radiographically to be too deep, resulting in residual internal chest depth of <10 mm for most patients of this age.
Braga
Matthew S
MS
Division of Pediatric Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA. matthew.s.braga@hitchcock.org
Dominguez
Troy E
TE
Pollock
Avrum N
AN
Niles
Dana
D
Meyer
Andrew
A
Myklebust
Helge
H
Nysaether
Jon
J
Nadkarni
Vinay
V
D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed