Background
Early and effective chest compressions have a well known pivot role in cardiopulmunary resuscitation (CPR) and 2010 International Consensus on Cardiopulmonary Resuscitation have strongly reinforced its importance.
The efficacy of chest compressions depends on hands position and on compression technique.
Medical education can improve chest compression technique, while the choice of thoracic landmark is always blind even if 2010 consensus indicated that it is reasonable to place the hands in the lower half of the sternum.
Objective
Critical care ultrasound (CCUS) has changed the approach of critical ill patient and can identify potential reversible causes of cardiac arrest during CPR.
Our challenge is to use CCUS to locate the most appropriate site for chest compressions.
Matherial and method
We planned a pilot study (in progress) to evaluate the capability of CCUS to improve the quality of chest compressions while CPR is taking place.
Results
We describe data of a small case series from 6 non traumatic cardiac arrests who was treated both in-hospital and in pre-hospital settings.
In 3 out of 6 patients compressions were correctly performed while in the other 3 cases partials left ventricle compression or the narrowing of the base of the heart and aorta was observed. Ultrasound guided changes in hands position improved passive left ventricle contractility in the 3 incorrect CPR.
Conclusions
Our study doesn’t permit to estimate if the changes made in hands position would have affected the outcome of CPR.
Anyway we think that the possibility to focus the power of the hands over the real position of left ventricle certainly improves the quality of our chest compressions.
References
Sayre MR, Koster RW, Sayre MR, et al.: Adult Basic Life Support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010, 122: S298-S324. 10.1161/CIRCULATIONAHA.110.970996
Hwang SO, Zhao PG, Choi HJ, et al.: Compression of the Left Ventricular Outflow Tract During Cardiopulmonary Resuscitation. Acad Emerg Med 2009, 16: 928–933. 10.1111/j.1553-2712.2009.00497.x
Shin J, Rhee JE, Kim K: Is the inter-nipple line the correct hand position for effective chest compression in adult cardiopulmonary resuscitation? Resuscitation 2007, 75: 305–310. 10.1016/j.resuscitation.2007.05.003
Hoppmann RA, Bell FE, Hoppmann NA, et al.: Hand-held ultrasonography to assess external chest compressions on a fresh cadaver. Resuscitation 2013, 84(8):e93. 10.1016/j.resuscitation.2013.04.026
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Benato, P., Zanatta, M. & Cianci, V. Ultrasound guided chest compressions during cardiopulmonary resuscitation. Crit Ultrasound J 7 (Suppl 1), A32 (2015). https://doi.org/10.1186/2036-7902-7-S1-A32
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DOI: https://doi.org/10.1186/2036-7902-7-S1-A32