Optimal chest compression position for cardiopulmonary resuscitation determined by computed tomography image: retrospective cross-sectional analysis

Abstract

The objective of this study was to determine the height of optimal hand position for chest compression during adult cardiopulmonary resuscitation (CPR) from the tip of the sternal xiphoid process (TOX) along with the relative heights of the left ventricular outflow tract (LVOT) and abdominal organs among the Thai population. The retrospective cross-sectional study was conducted through a review of medical records and contrast-enhanced chest computed tomography. The total of 204 Thai patients without obvious chest deformity at Ramathibodi Hospital from January to June 2018 was included as part of a multi-regional study. The heights of the level of maximal LV width (LV_max), LOVT, top of liver and stomach with respect to TOX were measured on midline sagittal image. Mean age and body mass index (BMI) were 59.5 years and 23.9 kg/m², respectively. One hundred and one subjects (49.5%) had pulmonary diseases. Mean height of the LV_max from TOX was 37.7 mm, corresponding to 20% of the sternal length (SL) in the inspiration arm raised position (IAR). The adjusted height of LV_max from TOX in the expiration arm-down position (EAD) was 89.7 mm (48% of SL). The inter-nipple line was at 84.5 mm (45.1% of SL) from TOX on IAR. Among 178 and 109 subjects whose uppermost part of the liver and stomach were above TOX, 80.4% and 94.5% were located within the lower half of the sternum, respectively. The adjusted optimal hand position for chest compression during CPR was at approximately 89.7 mm from TOX in EAD (48% of SL). The hand position at the upper part of the lower half of the sternum is closest to the adjusted LV_max and has a better chance to avoid compression of intraabdominal organs.

Trial registration This trial was retrospectively registered on 2 February 2023 in the Thai Clinical Trial Registry, identification number TCTR 20230202006.