Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
Department of Physical Education, Kyungnam University, Changwon, South Korea.
Pediatr Crit Care Med. 2018 Jan;19(1):e1-e6. doi: 10.1097/PCC.0000000000001369.
The 2015 American Heart Association guidelines recommended pediatric rescue chest compressions of at least one-third the anteroposterior diameter of the chest, which equates to approximately 5 cm. This study evaluated the appropriateness of these two types by comparing their safeties in chest compression depth simulated by CT.
Retrospective study with data analysis conducted from January 2005 to June 2015 SETTING:: Regional emergency center in South Korea.
Three hundred forty-nine pediatric patients 1-9 years old who had a chest CT scan.
Simulation of chest compression depths by CT.
Internal and external anteroposterior diameter of the chest and residual internal anteroposterior diameter after simulation were measured from CT scans. The safe cutoff levels were differently applied according to age. One-third external anteroposterior diameters were compared with an upper limit of chest compression depth recommended for adults. Primary outcomes were the rates of overcompression to evaluate safety. Overcompression was defined as a negative value of residual internal anteroposterior diameter-age-specific cutoff level. Using a compression of 5-cm depth simulated by chest CT, 16% of all children (55/349) were affected by overcompression. Those 1-3 years old were affected more than those 4-9 years old (p < 0.001). Upon one-third compression of chest anteroposterior depth, only one subject (0.3%) was affected by overcompression. Rate of one-third external anteroposterior diameter greater than 6 cm in children 8 and 9 years old was 16.1% and 33.3%, respectively.
A chest compression depth of one-third anteroposterior might be more appropriate than the 5-cm depth chest compression for younger Korean children. But, one-third anteroposterior depth chest compression might induce deep compressions greater than an upper limit of compression depth for adults in older Korean children.
2015 年美国心脏协会指南建议儿科急救胸部按压深度至少为胸廓前后径的 1/3，相当于大约 5cm。本研究通过 CT 模拟胸部按压深度来评估这两种方法的适宜性。
2005 年 1 月至 2015 年 6 月进行的回顾性研究，数据分析。
韩国某地区急救中心。
349 名 1-9 岁儿童进行胸部 CT 扫描。
CT 模拟胸部按压深度。
从 CT 扫描中测量胸廓的内外前后径和模拟后的残余内部前后径。根据年龄，安全截止水平有不同的应用。将 1/3 的胸廓外部前后径与成人推荐的胸部按压深度上限进行比较。主要结果是评估安全性的过度按压率。过度按压定义为残余内部前后径-年龄特定截止水平的负值。使用 CT 模拟的 5cm 深度按压，16%的儿童（55/349）受到过度按压的影响。1-3 岁的儿童比 4-9 岁的儿童更容易受到影响（p < 0.001）。当胸廓前后深度压缩 1/3 时，只有 1 名儿童（0.3%）受到过度按压的影响。8 岁和 9 岁儿童的胸廓外部前后径 1/3 大于 6cm 的比例分别为 16.1%和 33.3%。
对于年龄较小的韩国儿童，1/3 胸廓前后径的胸部按压深度可能比 5cm 胸部按压深度更合适。但是，对于年龄较大的韩国儿童，1/3 胸廓前后径的胸部按压可能会导致深度按压超过成人按压深度上限。
