Ideal chest compression fraction8/27/2023 The regional ethical board approved the study (REK 2011/748) and participants gave their written consent. Demographic data was collected and patients categorized into three clinical groups based on the conclusions from the CMR radiologist: Cardiac disease, aortic disease or no findings/study patient. The MRI scans included evaluation of suspected or manifest diseases such as ischaemic heart disease, non-ischaemic heart disease (mainly hypertrophic/dilated cardiomyopathy, myocarditis, and arrhythmogenic right ventricular cardiomyopathy (ARVC)), aortic diseases, and patients taking part in other cardiovascular MRI studies (study patients). This was a prospective observational study of consecutive patients aged 16 and above referred to cardiovascular MRI (CMR) between January 2012 and June 2013. Finally, we defined a hypothesis generating optimal compression point (OCP) based on maximum compressible left and right ventricle. We then related the external anterior-posterior (AP) diameter of both the thorax and of its blood-filled structures, to the recommended chest compression depths. The purpose of this study was to establish how cardiovascular structures known to affect CPR, relate to surface anatomy in patients referred to cardiac magnetic resonance imaging (MRI). The ERC recommendations are regardless of gender, body size, and medical history. As to compression depths, European Resuscitation Council (ERC) decided in 2015 to retain the 2010 guidance that chest compressions should be at least 5 cm but not more than 6 cm, which equates to approximately one-fifth of the adult chest. Compression of the base of the heart or the LVOT might impede forward blood flow, whereas compression of both ventricles avoiding LVOT might be more effective. Previous CT studies have however shown that rather than the left ventricle, structures beneath the INL have been the ascending aorta, the root of aorta, or the left ventricular outflow tract (LVOT). According to the cardiac pump theory, direct compression of the ventricles is important. Forward blood flow during CPR is provided by compression of the heart (cardiac pump theory) and/or intra-thoracic pressure fluctuations (thoracic pump theory). Altered hand position might change compression of intrathoracic structures. However, there is little scientific evidence regarding the optimum hand position for chest compressions and the INL is an easily detectible surface landmark. The International Liaison Committee on Resuscitation (ILCOR) recommends placing the hands on the lower half of the sternum and concluded in 2010 that the use of the internipple line (INL) as a landmark for hand placement is not reliable. Conclusionsīased on our study, individualized compression point and depth could be further studied in a prospective, clinical study.Įffectiveness of chest compressions during cardiopulmonary resuscitation (CPR) can be altered by hand position and compression depth, among other components. Recommended chest compression depths exceeded the anterior-posterior diameter of blood-filled structures in more than half of the females. LVOT/AV/aortic root was present beneath the origo in almost half the patients with cardiac disease. Distance from origo to OCP was 32 (11) mm to the left and 16 (21) mm caudally. AP EXTERNAL for males and females was 25 (2) cm and 22 (2) cm, and AP BLOOD 6.5 cm (2) and 4.7 cm (2), respectively. The structure LVOT/aortic valve (AV)/aortic root was present in 46 % of patients with cardiac disease vs. ResultsĬonsecutive patients, mean (SD), age 52 (17) years, 110 (76 %) males, were categorized: cardiac disease ( n = 74), aortic disease ( n = 13), no findings/study patient (included in another study) ( n = 57). We measured the distance from origo to OCP. We defined OCP based on the image with maximum compressible left and right ventricle and where LVOT was not present. The blood-filled structures beneath origo were identified and the sum of their inner diameters (AP BLOOD) and AP EXTERNAL were measured. We defined origo as the skin surface of the centre of sternum in the internipple line. MRI axial scans of referred patients were analysed. Using magnetic resonance imaging (MRI) to relate cardiovascular structures to surface anatomy in a population relevant to cardiac arrest victims, relate the external thoracic anterior-posterior (AP) diameter (AP EXTERNAL) and blood-filled structures to recommended chest compression depths, and define an optimal compression point (OCP).
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