Optimum Position for External Cardiac Compression in Infants and Young Children

Abstract

Ninety-seven pediatric patients (age 67%) in all cases at all ages. Ten pediatric patients (between 1 month and 3 years of age) who sustained cardiac arrest while in the Pediatric and Surgical Intensive Care Unit and who had arterial pressure monitoring lines already in place were monitored with a two- or four-channel strip-chart recorder during external cardiac compression (ECC) performed by staff members who were blinded from the results of the strip-chart recording. The ECC performers were instructed to perform ECC at either the midsternum at the level of the victim's nipples or at the lower one-third of the sternum 1.5 to 2 cm above the tip of the xiphoid, and then to switch on command. In every instance in which the patients served as their own controls (ECC performed at both the midsternum and lower one-third of the sternum in random sequence), the performance of ECC over the lower one-third of the sternum resulted in significantly better systolic and mean arterial blood pressures ( P