Lee Che-uk, Hwang Ji Eun, Kim Joonghee, Rhee Joong Eui, Kim Kyuseok, Kim Taeyun, Jo You Hwan, Lee Jae Hyuk, Kim Yu Jin, Jung Jae Yun
Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
Am J Emerg Med. 2015 Dec;33(12):1755-9. doi: 10.1016/j.ajem.2015.08.014. Epub 2015 Aug 12.
Adequate chest compression (CC) depth is critical for effective cardiopulmonary resuscitation. Pediatric resuscitation guidelines recommend that CC be at least one-third of the anterior-posterior (AP) chest diameter or approximately 4 cm in infants and 5 cm in children. We aimed to find a better indicator of CC depth that maximizes CC depth while also minimizing injury.
Chest computed tomographic images of patients aged 8 years and younger were measured for external diameter (ED) (AP distance from skin to skin) and internal diameter (AP distance between internal surface of anterior chest wall and anterior surface of vertebral body) at the midway of the lower half of the sternum. Compressible depth was defined as 1 cm short of internal diameter. We determined that up to a 10% estimated risk of overcompression is acceptable and approximated a quantile regression line for the 10th percentile of compressible depth on ED. After rounding coefficients, we used its equation as a new indicator.
A total of 426 images were analyzed. The new indicator had a slope of 0.5 and an intercept of -1.9 cm (1 fingerbreadth). Compared to one-third ED, the new indicator would provide deeper CC with average difference of 1.9 mm (95% confidence interval, 1.6-2.2 mm) without increasing the risk of overcompression (both 4.9%). Chest compression of 4/5 cm would provide deeper CC compared to the new indicator (difference, 3.5 mm; 95% confidence interval, 2.7-4.1 mm); however, its overcompression risk was too high (31.5%).
Chest compression of one-half ED minus 1 fingerbreadth maximizes CC depth without increasing overcompression in pediatric population.
足够的胸部按压深度对于有效的心肺复苏至关重要。儿科复苏指南建议，婴儿胸部按压深度至少为前后胸径的三分之一，约4厘米，儿童为5厘米。我们旨在找到一个更好的胸部按压深度指标，既能使胸部按压深度最大化，又能将损伤降至最低。
对8岁及以下患者的胸部计算机断层扫描图像，在胸骨下半部中点测量外径（ED，从皮肤到皮肤的前后距离）和内径（前胸壁内表面与椎体前表面之间的前后距离）。可压缩深度定义为比内径短1厘米。我们确定，高达10%的过度按压估计风险是可以接受的，并近似得出可压缩深度第10百分位数关于外径的分位数回归线。对系数进行四舍五入后，我们将其方程用作新指标。
共分析了426张图像。新指标的斜率为0.5，截距为-1.9厘米（1指宽）。与三分之一外径相比，新指标能提供更深的胸部按压，平均差异为1.9毫米（95%置信区间，1.6 - 2.2毫米），且不会增加过度按压风险（两者均为4.9%）。与新指标相比，4/5厘米的胸部按压能提供更深的胸部按压（差异为3.5毫米；95%置信区间，2.7 - 4.1毫米）；然而，其过度按压风险过高（31.5%）。
在儿科人群中，胸部按压深度为外径的一半减去1指宽可使胸部按压深度最大化，且不会增加过度按压风险。
