title: The importance of victim chest exposure during cardiopulmonary resuscitation: a simulation study.
abstract: BACKGROUND
  During cardiopulmonary resuscitation (CPR), inaccurate positioning of the rescuer's hand might damage internal organs due to compression around the xiphoid process.
  
  
  OBJECTIVE
  This study aimed to determine whether exposing the victim's chest during CPR would help adequate positioning of a rescuer's hand on the chest.
  
  
  METHODS
  This simulation study included 187 participants. We gave them four photographs each of exposed chests and unexposed chests. Participants were then asked to mark a cross at the center of the chest (CoC) and at the inter-nipple line (INL), and we measured the width of participants' palms to estimate the range of hand contact with the victim's chest. Finally, we compared the position and distribution of the CoC and INL markings and analyzed whether the hand contact range on the victim's chest involved the xiphoid process.
  
  
  RESULTS
  The participants' CoC markings were similar regardless of whether the pictures showed an exposed or unexposed chest (p = 0.638). However, the level of INL marking was significantly lower in pictures of an exposed chest (p < 0.001). When exposing the chest, the distribution of markings was narrower for both CoC (p = 0.001) and INL (p < 0.001). The proportion of CoC markings involving the xiphoid process were lower when the chest was exposed (10.7%) than when was clothed (12.3%) (p < 0.001). Similarly, INL markings involving the xiphoid process followed the same trend in exposed vs. unexposed chest images (0% vs. 1.6%, respectively).
  
  
  CONCLUSIONS
  Exposing the chest during CPR can improve the rescuer's ability to recognize the CoC and INL, leading to more intense chest compression and reducing the risk of inaccurate compression.
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Korea.
authors.forename: Choong Hyun
authors.initials: CH
authors.lastname: Jo
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Korea.
authors.forename: Gyu Chong
authors.initials: GC
authors.lastname: Cho
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Korea.
authors.forename: Jung Hwan
authors.initials: JH
authors.lastname: Ahn
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Korea.
authors.forename: Ji Yeong
authors.initials: JY
authors.lastname: Ryu
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D016544:Patient Simulation; D011446:Prospective Studies; D014989:Xiphoid Bone / Q000293:injuries; D055815:Young Adult
keywords: cardiopulmonary resuscitation; chest compression; chest exposure