Optimal Chest Compression Depth for Children Determined by Chest Computed Tomography

Park, Jung Hoon; Je, Sang Mo; You, Je Sung; Kim, Sun Wook; Chung, Tae Nyoung; Kim, Min Joung; Park, Yoo Seok; Chung, Sung Phil; Park, Incheol

Abstract

PURPOSE
The recommended compression depth for basic life support of pediatric patients is one third to one half the anterior-posterior diameter of the chest. This study was designed to evaluate, using chest computed tomography (CT), whether the recommended compression depth is appropriate.
METHODS
Data for pediatric patients who underwent chest computed tomography were collected. Axial images containing both nipples were selected. We measured external chest thickness, internal thickness from sternum to vertebral body, and residual thickness; the latter was defined as internal thickness minus one third or one half of external thickness. We assumed potential injury would occur from chest compression if residual thickness was less than 10 mm.
RESULTS
Chest CT images from 164 children were analyzed. The compression depth was 62.4+/-6.9 mm if one half of the chest thickness was compressed, which was deeper than the high margin of compression depth recommended for adults. No potential injury was assumed when compressing one third of external chest thickness, while 96.3% of patients were assumed to sustain an injury when receiving compressions as deep as one half of chest thickness.
CONCLUSION
One half the anterior-posterior diameter of the chest, the compression depth for pediatric CPR recommended in the current guidelines, is deeper than the 4~5 cm depth recommended for adult chest compression, and will result in less than 10 mm of residual thickness in most cases. This may cause internal organ injury.