앙와위와 좌측 기울린위치에서의 좌심실의 공간적 관계 변화. 임신부 심폐소생술 측면에서

Abstract

Application of the left lateral tilt position has been recommended during cardiopulmonary resuscitation (CPR) of pregnant patients. However, the left lateral tilt could displace the left ventricle (LV) besides the gravid uterus and may compromise the cardiac pump mechanism of CPR. Thus, we investigated the effect of left lateral tilt on the spatial relationship between the anterior-posterior axis (AP axis), which represents the direction of sternal displacement during CPR, and the LV. We retrospectively reviewed the medical records and multidetector computed tomography (MDCT) scans of 90 patients who underwent virtual gastroscopy using MDCT. Virtual gastroscopy was performed with the patient both in the left lateral tilt position and in the supine position. On an axial image showing the maximal area of the LV, the angle between the AP axis and the LV axis (), the shortest distance between the AP axis and the mid-point of LV cavity () and the shortest distance between the AP axis and the LV apex () were measured. In the supine scans, the LV was situated on the left side of the AP axis in 87 patients (96.7%). On the left lateral tilt scans, the mean tilt angle was . and were significantly longer in the left lateral tilt position (p was comparable between the positions. This study indicates that the left lateral tilt position may compromise the cardiac pump mechanism of chest compression in pregnant cardiac arrest patients.