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Verification of the Optimal Chest Compression Depth for Children in the 2015 American Heart Association Guidelines: Computed Tomography Study

Kim, Yong Hwan MD1; Lee, Jun Ho MD1; Cho, Kwang Won MD1; Lee, Dong Woo MD1; Kang, Mun Ju MD1; Lee, Kyoung Yul PhD2; Byun, Joung Hun MD3; Lee, Young Hwan MD4; Hwang, Seong Youn MD, PhD1; Lee, Na Kyoung RN5

Pediatric Critical Care Medicine: January 2018 - Volume 19 - Issue 1 - p e1-e6
doi: 10.1097/PCC.0000000000001369
Online Clinical Investigations
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Objective: The 2015 American Heart Association guidelines recommended pediatric rescue chest compressions of at least one-third the anteroposterior diameter of the chest, which equates to approximately 5 cm. This study evaluated the appropriateness of these two types by comparing their safeties in chest compression depth simulated by CT.

Design: Retrospective study with data analysis conducted from January 2005 to June 2015

Setting: Regional emergency center in South Korea.

Patients: Three hundred forty-nine pediatric patients 1–9 years old who had a chest CT scan.

Interventions: Simulation of chest compression depths by CT.

Measurements and Main Results: Internal and external anteroposterior diameter of the chest and residual internal anteroposterior diameter after simulation were measured from CT scans. The safe cutoff levels were differently applied according to age. One-third external anteroposterior diameters were compared with an upper limit of chest compression depth recommended for adults. Primary outcomes were the rates of overcompression to evaluate safety. Overcompression was defined as a negative value of residual internal anteroposterior diameter—age-specific cutoff level. Using a compression of 5-cm depth simulated by chest CT, 16% of all children (55/349) were affected by overcompression. Those 1–3 years old were affected more than those 4–9 years old (p < 0.001). Upon one-third compression of chest anteroposterior depth, only one subject (0.3%) was affected by overcompression. Rate of one-third external anteroposterior diameter greater than 6 cm in children 8 and 9 years old was 16.1% and 33.3%, respectively.

Conclusions: A chest compression depth of one-third anteroposterior might be more appropriate than the 5-cm depth chest compression for younger Korean children. But, one-third anteroposterior depth chest compression might induce deep compressions greater than an upper limit of compression depth for adults in older Korean children.

1Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.

2Department of Physical Education, Kyungnam University, Changwon, South Korea.

3Department of Thoracic and Cardiovascular Surgery, Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea.

4Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.

5Department of Nursing, Graduate School, Kyung Hee University, Seoul, South Korea.

New affiliation for Young Hwan Lee: Department of Emergency Medicine, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.

New affiliation for Na Kyoung Lee: Department of Nursing Science, College of Kyungbuk, Yeongju, South Korea.

This study was performed at Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.

Supported by a Samsung Biomedical Research Institute grant.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail Dr. Hwang: 3syellow@naver.com

Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies