title: Evaluation of the 2010 American Heart Association Guidelines for infant CPR finger/thumb positions for chest compression: a study using computed tomography.
abstract: BACKGROUND
  We sought to verify, using computed tomography (CT) examinations of infants, which the left ventricle (LV) is compressed and abdominal compression avoided by using the chest compression landmarks recommended by the 2010 American Heart Association (AHA) Guidelines for infant cardiopulmonary resuscitation (CPR).
  
  
  METHODS
  Using CT examinations of 63 infants performed between March 2002 and July 2011, we retrospectively measured the distance between the INL and the xiphoid process, and the distance of the lower third (LT) of the sternum. The distances between LV maximal diameter (LVMD) and xiphoid processes were also measured to determine whether LVs would be compressed by chest compressions. These distances were compared with the finger placements by 20 adults, when placed on infant mannequins for simulated two-finger or two-thumb infant CPR.
  
  
  RESULTS
  The mean distances of the INL and the LT of the sternum were 32 ± 8 mm and 12 ± 2 mm from the xiphoid, respectively. The LVMD was placed 15 ± 6 mm from the xiphoid process. When we overlaid the width of adult finger placement (a mean of 28 mm for two-finger technique, and 23 mm for two-thumb technique), the LV was compressed in 57 patients (90.5%) and 59 patients (93.7%), respectively. The upper abdomen was compressed in 22 patients (34.9%) by the two-finger technique and in 16 patients (25.3%) by the two-thumb technique with the range of 0.3-10.8mm.
  
  
  CONCLUSIONS
  When applying the 2010 AHA Guidelines for infant CPR, recommended finger placement allows for adequate compression of the LV in more than 90% of patients. In 23-35% of infants, the upper abdomen is compressed from 0.3mm to 10.7 mm.
authors.affiliation: School of Medicine, Gachon University, Incheon, Republic of Korea.
authors.forename: Ki Hyun
authors.initials: KH
authors.lastname: Lee
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.forename: Dae Hong
authors.initials: DH
authors.lastname: Park
authors.forename: Jee-Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Hye-Young
authors.initials: HY
authors.lastname: Choi
authors.forename: Jinseong
authors.initials: J
authors.lastname: Cho
authors.forename: Hyuk Jun
authors.initials: HJ
authors.lastname: Yang
mesh_terms: D000572:American Heart Association; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards; D005260:Female; D005385:Fingers; D019983:Guideline Adherence; D006323:Heart Arrest / Q000000981:diagnostic imaging / Q000628:therapy*; D006336:Heart Massage / Q000379:methods* / Q000592:standards; D006801:Humans; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013933:Thumb; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014481:United States