Evaluation of the 2010 American Heart Association Guidelines for infant CPR finger/thumb positions for chest compression: A study using computed tomography

Abstract

IntroductionWe 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). MethodsUsing 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. ResultsThe mean distances of the INL and the LT of the sternum were 32±8mm and 12±2mm from the xiphoid, respectively. The LVMD was placed 15±6mm from the xiphoid process. When we overlaid the width of adult finger placement (a mean of 28mm for two-finger technique, and 23mm 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. ConclusionWhen 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 10.7mm.