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. 2024 Aug 1;25(8):720-727.
doi: 10.1097/PCC.0000000000003515. Epub 2024 Apr 11.

Chest Compression Depth Targets in Critically Ill Infants and Children Measured With a Laser Distance Meter: Single-Center Retrospective Study From Japan, 2019-2022

Takanari Ikeyama  1   2 , Takunori Hozumi  1 , Kazuki Kikuyama  1 , Dana Niles  3 , Vinay Nadkarni  3 , Komei Ito  2
Affiliations

Chest Compression Depth Targets in Critically Ill Infants and Children Measured With a Laser Distance Meter: Single-Center Retrospective Study From Japan, 2019-2022

Takanari Ikeyama et al. Pediatr Crit Care Med. .

Abstract

Objectives: Current resuscitation guidelines recommend target chest compression depth (CCd) of approximately 4cm for infants and 5cm for children. Previous reports based on chest CT suggest these recommended CCd targets might be too deep for younger children. Our aim was to examine measurements of anterior-posterior chest diameter (APd) with a laser distance meter and calculate CCd targets in critically ill infants and children.

Design: A retrospective descriptive study.

Setting: Single-center PICU, using data from May 2019 to May 2022.

Patients: All critically ill children admitted to PICU and under 8 years old were eligible to be included in the retrospective cohort.

Interventions: None.

Measurements and main results: The chest APd measurements using a laser distance meter are part of our usual practice on the PICU. Target CCd and the over-compression threshold CCd for each age group was calculated as 1/3 and 1/2 of APd, respectively. In 555 patients, the median (interquartile range) of the calculated target CCd for each age group was: 2.7 cm (2.5-2.9 cm), 2.9 cm (2.7-3.2 cm), 3.2 cm (3-3.5 cm), 3.4 cm (3.2-3.6 cm), 3.4 cm (3.2-3.6 cm), 3.6 cm (3.4-3.8 cm), 3.6 cm (3.4-4 cm), and 4 cm (3.5-4.2 cm), for 0, 2, 3-5, 6-8, 9-11, 12-17, 18-23, 24 to less than 60, and 60 to less than 96 months, respectively. Using guideline-recommended absolute CCd targets, 4 cm for infants and 5 cm for children, 49% of infants between 0 and 2 months, and 45.5% of children between 12 and 17 months would be over-compressed during cardiopulmonary resuscitation.

Conclusions: In our cohort, the 1/3 CCd targets calculated from APd measured by laser meter were shallower than the guideline-recommended CCd. Further studies including evaluating hemodynamics during cardiopulmonary resuscitation with these shallower CCd targets are needed.

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Conflict of interest statement

Dr. Nadkarni received unrestricted research funding to his institution from the National Institutes of Health, Agency for Healthcare Research and Quality, ZOLL Medical Corporation, Nihon Kohden, and Volunteers on Scientific Advisory Committees for the American Heart Association, Citizen Cardiopulmonary Resuscitation (CPR) Foundation, the International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE), and Citizen CPR; he received funding from the Society of Critical Care Medicine and the Laerdal Foundation; and he is the President of the Society of Critical Care Medicine to 2023. Ms. Niles disclosed that the Children’s Hospital of Philadelphia receives support from an unrestricted research grant from ZOLL Medical Corporation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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