Optimum location for chest compressions during two-rescuer infant cardiopulmonary resuscitation.
OBJECTIVE
The study aims to evaluate the optimal chest compression site in two-rescuer infant cardiopulmonary resuscitation (CPR).


METHODS
Charts and multidirectional computed tomography images of infants who presented to one of four hospitals from March 2004 to March 2009 were reviewed retrospectively. The length of the sternum (S(total)), the length and width (L, W) of adult thumbs after two thumbs were placed side-by-side were measured. The study included the structures located underneath the lower third of S(total) (S(total/3)), the lower half of S(total) (S(total/2)), the sternum at the inter-nipple line (S(n)), the point of maximal anterior-posterior heart diameter (S(m)), the lower margin of L and the lateral margin of W from S(total/3), S(total/2), S(n) and S(m).


RESULTS
Of the 75 infants enrolled, the ratio of the length from the xiphoid process to S(m) from S(total) was 0.24+/-0.19. In the population studied, 43.1% had aortic roots in S(total/2), 44.0% had left ventricular outflow tracts in S(total/3), 46.7% had left ventricular outflow tracts at S(n) and 100.0% had left ventricles at S(m). All the infants had livers in the lower margin of L from S(m) and all of them had hearts in the left lateral margin of half of W from S(m). A total of 42.7% had lungs in the right lateral margin of half of W from S(m).


CONCLUSIONS
The left ventricle was located in the lower quarter of the sternum, lower than S(total/3). However, more studies are needed to validate the efficiency and safety of compressing the lower quarter of the sternum in two-rescuer infant CPR.
You
YeonHo
Y
Department of Emergency Medicine, College of Medicine, Chungnam National University Hospital, 640 Daesa-dong Jung-gu Metropolitan City, Daejeon, South Korea. yyo1003@naver.com
D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D006225:Hand; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008348:Manikins; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013249:Sternum / Q000000981:diagnostic imaging*; D035441:Thoracic Wall / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome