Optimum location for chest compressions during two-rescuer infant cardiopulmonary resuscitation

ObjectivesThe study aims to evaluate the optimal chest compression site in two-rescuer infant cardiopulmonary resuscitation (CPR).MethodsCharts and multidirectional computed tomography images of infants who presented to one of four hospitals from March 2004 to March 2009 were reviewed retrospectively. The length of the sternum (Stotal), the length and width (L, W) of adult thumbs after two thumbs were placed side-by-side were measured. The study included the structures located underneath the lower third of Stotal (Stotal/3), the lower half of Stotal (Stotal/2), the sternum at the inter-nipple line (Sn), the point of maximal anterior–posterior heart diameter (Sm), the lower margin of L and the lateral margin of W from Stotal/3, Stotal/2, Sn and Sm.ResultsOf the 75 infants enrolled, the ratio of the length from the xiphoid process to Sm from Stotal was 0.24 ± 0.19. In the population studied, 43.1% had aortic roots in Stotal/2, 44.0% had left ventricular outflow tracts in Stotal/3, 46.7% had left ventricular outflow tracts at Sn and 100.0% had left ventricles at Sm. All the infants had livers in the lower margin of L from Sm and all of them had hearts in the left lateral margin of half of W from Sm. A total of 42.7% had lungs in the right lateral margin of half of W from Sm.ConclusionThe left ventricle was located in the lower quarter of the sternum, lower than Stotal/3. However, more studies are needed to validate the efficiency and safety of compressing the lower quarter of the sternum in two-rescuer infant CPR.