Current Guideline of Chest Compression Depth for Children of All Ages May Be Too Deep for Younger Children

Abstract

Aim: To determine whether the chest compression depth of at least 1/3 of the Anteroposterior (AP) diameter of the chest and about 5 cm is appropriate for children of all age groups via chest computed tomography.

Methods: The AP diameter of the chest, anterior chest wall diameter, and compressible diameter (Cd) were measured at the lower half of the sternum for patients aged 1-18 years using chest computed tomography. The mean ratio of 5 cm compression to the Cd of adult patients was used as the lower limit, and the mean ratio of 6 cm compression to the Cd of adult patients was used as the upper limit. Also, the depth of chest compression resulting in a residual depth <1 cm was considered to cause internal injury potentially. With the upper and lower limits, the compression ratios to the Cd were compared when compressions were performed at a depth of 1/3 the AP diameter of the chest and 5 cm for patients aged 1-18 years.

Results: Among children aged 1-7 years, compressing 5 cm was deeper than 1/3 the AP diameter. Also, among children aged 1-5 years, 5 cm did not leave a residual depth of 1 cm, potentially causing intrathoracic injury.

Conclusion: Current pediatric resuscitation guidelines of chest compression depth for children were too deep for younger children aged 1-7 years.

Figure 1

Measured diameters on an axial chest CT image at the level of the lower half of the sternum. APd was defined as the distance from the anterior skin to the posterior skin. ACWd was defined as the distance from the anterior skin to the posterior sternum. Cd was defined as the distance from the posterior sternum to the anterior vertebral body. APd: anteroposterior diameter; ACW: anterior chest wall diameter; C: compressible diameter.

Figure 2

Means and standard deviation plots of APd, ACWd, and Cd by age group among patients aged 1–18 years. Black circles represent means and the error bars represent standard deviations. APd: anteroposterior diameter; ACWd: anterior chest wall diameter; Cd: compressible diameter.

Figure 3

Compression depth to Cd ratios when chest compressions were performed at 1/3 of the APd or 5 cm by age group among patients aged 1–18 years. The white and black circles represent the mean ratios. The gray area represents the range of compression depth to Cd ratio when chest compressions were performed between 5 cm (47.3%) and 6 cm (56.7%) in adults. The gray bold line and the gray double line are the boundaries that indicate the residual depth of 1 cm and 2 cm, respectively. APd: anteroposterior diameter; Cd: compressible diameter.

Figure 4

Linear regression analysis of Cd and 1/3 of the APd by age group among patients aged 1–18 years. Linear prediction lines (bold solid lines: unadjusted, fine solid and dotted lines: adjusted for sex) are shown with means (black circle) and standard deviations (error bars) by age. In some subjects with a Cd of less than 6 cm among 1 to 5 years of age, the residual depth is less than 1cm if chest compression is delivered by 5 cm depth (oblique-lined area). Chest compression depth is deeper when the chest was compressed by 5 cm than 1/3 of the APd in children between one to 7 years old (gray-colored area). APd: anteroposterior diameter; Cd: compressible diameter.