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20 July 2010

CPR Chest Compression Depth Guidelines in Children May Need Revision

The chest compression depth recommended in cardiopulmonary resuscitation (CPR) guidelines for pediatric patients do not appear to be optimal and may be excessive, according to studies in the July issue of Pediatrics.
The studies used computed tomography reconstruction to estimate chest compression depths that would be optimal for infants and children up to 8 years old during cardiopulmonary resuscitation. Current guidelines in that age group call for compressions of one third to one half the external anterior-posterior chest depth.
Dr. Matthew Braga at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and co-authors blame low rates of survival among children who experience cardiac arrest on unproven targets for pediatric chest compressions that are based on extrapolation from adults and animal models.
To provide direct experimental data, Dr. Braga's team examined pediatric chest CT scans previously performed to measure individual chest depths in 14 age groups between birth and 8 years.
Results show that "the current recommendations of one third to one half external anterior-posterior chest depth are not ideal and may not be attainable or safe for all children."
For example, a one-half chest compression in 3- to 12-month-olds would theoretically result in 25% having no residual internal depth, causing harm to structures being compressed. The authors estimate that the same would be true for 21% of 1- to 3-year-olds, and 8% of 3- to 8-year-olds.
According to Dr. Braga and associates, "Use of a constant chest compression depth target of 38 mm would be expected to be adequate for > 98% of 1 to 8-year-old children, with > 10 mm of residual chest depth."
Dr. Matthew Huei-Ming Ma and associates at National Taiwan University Hospital, Taipei, take a similar tack, using chest CT scans of 36 infants and 38 children ages 1 to 8.
They observed that accurate depths of chest compression at the lower half of the sternum and the internipple line revealed no significant difference. Therefore, they maintain, "because guidelines should be modified and simplified for ease of use by either the layperson or health care provider, it is not necessary to provide two choices in the pediatric resuscitation guidelines in the future."
Dr. Ma's team also observed that compression depths according to current guidelines were similar to or even higher than recommended compression depths for adults.
"More scientific debate is needed on this issue for further revision of pediatric CPR guidelines," they conclude.
Pediatrics 2009;124:e69-e74.
Source : http://www.medscape.com/viewarticle/705045?sssdmh=dm1.492967&src=nldne
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