title: Estimation of anatomical structures underneath the chest compression landmarks in children by using computed tomography.
abstract: OBJECTIVE
  There has been little investigation on the appropriateness of the hand position suggested by various guidelines in paediatric cardiopulmonary resuscitation (CPR). We aimed to identify anatomical structures underneath the chest compression landmarks and tried to find the proper hand position using computed tomography (CT) images for more effective paediatric CPR.
  
  
  METHODS
  This study included a total of 181 paediatric patients who were admitted to Severance Hospital and underwent CTs of chest. We studied structures located under the inter-nipple line and under the lower third of the sternum. The distances from the xiphoid process to the level of the left ventricular outflow tract (LVOT) were measured to find the ceiling on the proper hand position.
  
  
  RESULTS
  The LVOT (42.0%) and the root of the aorta (21.5%) were more frequently located than the left ventricle under the inter-nipple line, and the liver was located under the lower third of the sternum in a significant number of patients (28.7%). The LVOT was placed 6.8±13.9 mm below the nipple level, but there was no significant difference in the distance from the nipple level to the LVOT among the age groups (p=0.517).
  
  
  CONCLUSIONS
  The hand position at the inter-nipple line might be too high and that at the lower third of the sternum might be too low as it can compress the liver. Further studies are needed to find the proper hand position for more effective chest compression during paediatric CPR.
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, 120-752 Seoul, Republic of Korea.
authors.forename: Yoo Seok
authors.initials: YS
authors.lastname: Park
authors.forename: Incheol
authors.initials: I
authors.lastname: Park
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Tae Nyoung
authors.initials: TN
authors.lastname: Chung
authors.forename: Sun Wook
authors.initials: SW
authors.lastname: Kim
authors.forename: Min Joung
authors.initials: MJ
authors.lastname: Kim
authors.forename: Sung Phil
authors.initials: SP
authors.lastname: Chung
authors.forename: Hahn Shick
authors.initials: HS
authors.lastname: Lee
mesh_terms: D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006225:Hand; D006336:Heart Massage / Q000592:standards*; D006801:Humans; D007223:Infant; D008297:Male; D009558:Nipples; D011187:Posture; D012189:Retrospective Studies; D013249:Sternum; D035441:Thoracic Wall / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed