title: Clinical pilot study of different hand positions during manual chest compressions monitored with capnography.
abstract: OBJECTIVE
  Optimal hand position for chest compressions during cardiopulmonary resuscitation is unknown. Recent imaging studies indicate significant inter-individual anatomical variations, which might cause varying haemodynamic responses with standard chest compressions. This prospective clinical pilot study intended to assess the feasibility of utilizing capnography to optimize chest compressions and identify the optimal hand position.
  
  
  METHODS
  Intubated cardiac arrest patients treated by the physician manned ambulance between February and December 2011 monitored with continuous end-tidal CO2 (EtCO2) measurements were included. One minute of chest compressions at the inter-nipple line (INL) optimized using EtCO2 feedback, was followed by four 30-s intervals with compressions at four different sites; INL, 2 cm below the INL, 2 cm below and to the left of INL and 2 cm below and to the right of INL.
  
  
  RESULTS
  Thirty patients were included. At the end of each 30-s interval median (range) EtCO2 was 3.1 kPa (0.7-8.7 kPa) at INL, 3.5 kPa (0.5-10.7) 2 cm below INL, 3.5 kPa (0.5-10.3 kPa) 2 cm below and to the left of INL, and 3.8 kPa (0.4-8.8 kPa) 2 cm below and to the right of INL (p=0.4). The EtCO2 difference within each subject between hand positions with maximum and minimum values varied between individuals from 0.2 to 3.4 kPa (median 0.9 kPa).
  
  
  CONCLUSIONS
  Monitoring and optimizing chest compressions using capnography was feasible. We could not demonstrate one superior hand position, but inter-individual differences suggest optimal hand position might vary significantly among patients.
authors.affiliation: Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Pb 4956 Nydalen, N-0424 Oslo, Norway. ericmq@medisin.uio.no
authors.forename: Eric
authors.initials: E
authors.lastname: Qvigstad
authors.forename: Jo
authors.initials: J
authors.lastname: Kramer-Johansen
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Tømte
authors.forename: Tore
authors.initials: T
authors.lastname: Skålhegg
authors.forename: Øyvar
authors.initials: Ø
authors.lastname: Sørensen
authors.forename: Kjetil
authors.initials: K
authors.lastname: Sunde
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Olasveengen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D019296:Capnography; D002245:Carbon Dioxide / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006225:Hand; D006336:Heart Massage / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D056888:Patient Positioning; D010865:Pilot Projects; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide
keywords: Advanced life support; Capnography; Carbon dioxide; Cardiac arrest; Chest compressions