• Keunha Hwang, Sung-Bin Chon, and Jung Gi Im.
• Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Gyeonggi-Do, Republic of Korea.
• Am J Emerg Med. 2017 Dec 1; 35 (12): 1899-1906.

BackgroundTo determine the optimum chest compression site during cardiopulmonary resuscitation (CPR) with regard to heart failure (HF) by applying three-dimensional (3D) coordinates on computed tomography (CT).MethodsThis retrospective, cross-sectional study involved adults who underwent echocardiography and CT on the same day from 2007 to 2017. Incomplete CT images or information on HF, cardiac medication between echocardiography and CT, or thoracic abnormalities were excluded. Cases were checked whether they had HF through symptom/sign assessment, N-terminal pro-B type natriuretic peptide, and echocardiography. We set the xiphisternal joint's midpoint as the reference (0, 0, 0) to draw a 3D coordinate system, designating leftward, upward, and into-the-thorax directions as positive. The coordinate of the maximum LV diameter's midpoint (P_max.LV) was identified.ResultsEnrolled were 148 patients (63.0±15.1 years) with 87 females and 76 HF cases. P_max.LV of HF cases was located more leftwards, lower, and deeper than non-HF cases (5.69±0.98, -1.51±1.67, 5.76±1.09 cm vs. 5.00±0.83, -0.99±1.36, 5.25±0.71 cm, all p<0.05). Fewer HF cases had their LV compressed than non-HF cases (59.2% vs. 77.8%, p=0.025) when being compressed according to the current guidelines. The aorta (vs. LV) was compressed in 85.5% and 81.9% of HF and non-HF cases, respectively, at 3 cm above the xiphisternal joint. At 6cm above the joint, the highest allowable position according to the current guidelines, all victims would have their aorta compressed directly during CPR rather than the LV.ConclusionsThe lowest possible sternum just above the xiphisternal joint should be compressed especially for HF patients during CPR.Copyright © 2017 Elsevier Inc. All rights reserved.

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