Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. e69-e74 (doi:10.1542/peds.2009-0153)

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ARTICLE

Estimation of Optimal CPR Chest Compression Depth in Children by Using Computer Tomography

Matthew S. Braga, MD^a, Troy E. Dominguez, MD^b, Avrum N. Pollock, MD^c, Dana Niles, MS^b, Andrew Meyer, MD^d, Helge Myklebust, PhD^e, Jon Nysaether, PhD^e and Vinay Nadkarni, MD^b

^a Division of Pediatric Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Departments of ^b Anesthesiology and Critical Care Medicine
^c Radiology
^d Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
^e Department of Research and Development, Laerdal Medical AS, Stavanger, Norway

OBJECTIVE: Pediatric consensus-driven cardiopulmonary resuscitation guidelines target chest compression (CC) depths of one third to one half anterior-posterior (AP) chest depth. Estimates for this target as assessed by computed tomography (CT) measurements of internal and external AP chest dimensions could direct future pediatric cardiopulmonary resuscitation guidelines.

METHODS: A total of 280 consecutive chest CT scans in permuted blocks of 20 for each of 14 age divisions between 0 and 8 years were reconstructed and analyzed. External and internal AP depths were measured at midsternum, and residual chest depth was calculated at simulated one-third and one-half AP compressions.

RESULTS: After a simulated compression calculation, one-half external AP depth CC would result in residual internal depth of <10 mm for 94% (263 of 280) of children 3 months to 8 years. For a one-third external AP CC, only 0.4% (1 of 280) of children 3 months to 8 years had a calculated residual internal chest depth <10 mm.

CONCLUSIONS: By using CT reconstruction estimates of chest dimensions across the developmental spectrum from 0 to 8 years of age, we demonstrated that a simulated CC targeting approximately one-third external AP chest depth seems radiographically appropriate for children aged 3 months to 8 years, whereas simulated CC targeting approximately one-half external AP chest depth seems radiographically to be too deep, resulting in residual internal chest depth of <10 mm for most patients of this age.

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Key Words: chest films • pediatrics • pediatric advance life support • resuscitation

Abbreviations: CC—chest compression • AHA—American Heart Association • ERC—European Resuscitation Council • ILCOR—International Liaison Committee on Resuscitation • CPR—cardiopulmonary resuscitation • CT—computed tomography • AP—antero-posterior

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Accepted Feb 24, 2009.

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