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. 2020 Aug;12(8):4299-4306.
doi: 10.21037/jtd-20-702.

Efficacy of standard chest compressions in patients with Nuss bars

Joshua D Stearns  1 , Jaffalie Twaibu  2 , Dzifa Kwaku  2 , Vincent Pizziconi  2 , James Abbas  2 , Ashwini Gotimukul  3 , Dawn E Jaroszewski  3
Affiliations

Efficacy of standard chest compressions in patients with Nuss bars

Joshua D Stearns et al. J Thorac Dis. 2020 Aug.

Abstract

Background: The Nuss procedure temporarily places intrathoracic bars for repair of pectus excavatum (PE). The bars may impact excursion and compliance of the anterior chest wall while in place. Effective chest compressions during cardiopulmonary resuscitation (CPR) require depressing the anterior chest wall enough to compress the heart between sternum and spine. We assessed the force required to perform the American Heart Association's recommended chest compression depth after Nuss repair.

Methods: A lumped element elastic model was developed to simulate the relationship between chest compression forces and displacement with focus on the amount of force required to achieve a depth of 5 cm in the presence of 1-3 Nuss bars. Literature review was conducted for evidence supporting potential use of active abdominal compressions and decompression (AACD) as an alternative method of CPR.

Results: The presence of bars notably lowered compression depth by a minimum of 69% compared to a chest without bar(s). The model also demonstrated a dramatic increase (minimum of 226%) in compressive forces required to achieve recommended 5 cm depth. Literature review suggests AACD could be an alternative CPR in patients with Nuss bar(s).

Conclusions: In our model, Nuss bars limited the ability to perform chest compressions due to increased force required to achieve a 5 cm compression. The greater the number of Nuss bars present the greater the force required. This may prevent effective CPR. Use of active abdominal compressions and decompressions should be studied further as an alternative resuscitation modality for patients after the Nuss procedure.

Keywords: Funnel chest/surgery; cardiopulmonary resuscitation (CPR)/education; cardiopulmonary resuscitation (CPR)/methods; pectus excavatum (PE).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-702). DEJ reports personal fees and other from ZimmerBioMet, Inc., outside the submitted work; in addition, DEJ has a patent ZimmerBioMet with royalties paid. DEJ discloses consulting and intellectual property rights under Mayo Clinic Ventures with Zimmer Biomet, Inc. DEJ also serves as an unpaid editorial board member of Journal of Thoracic Disease from Dec 2018 to Nov 2020. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Drawing of the intrathoracic placement of Nuss bars for repair of pectus excavatum deformity.
Figure 2
Figure 2
Preoperative and postoperative images with severe pectus excavatum deformity who underwent Nuss procedure. (A) Magnetic resonance imaging shows a 23-year-old male with severe pectus excavatum deformity (Haller Index >8) with the anterior wall depressed inward; (B) preoperative and (C) postoperative photographs of patient; (D) chest roentgenogram postoperative with 2 Nuss bars in place after excavatum repair.
Figure 3
Figure 3
Lumped element elastic model showing elasticity configuration of the chest relative to Nuss bar(s).
Figure 4
Figure 4
Graph showing how the required compressive force would increase to achieve recommended compression depth due to the presence of Nuss bar(s).
Figure 5
Figure 5
Graph showing how the presence of Nuss bar(s) affects chest response to compressive forces during standard CPR. CPR, cardiopulmonary resuscitation.
See this image and copyright information in PMC

References

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