Could One-Hand Chest Compression for a Small Child Cause Intra-Abdominal Injuries?

Authors: Yeon Ho You, Ji Sook Lee, Jin Hong Min

Abstract:

We examined whether children ( < 18 years old) had risk of intra-thoracic trauma during 'one-handed' chest compressions through MDCT images. We measured the length of the lower half of the sternum (Stotal/2~X). We also measured the distance from the diaphragm to the midpoint of the sternum (Stotal/2~D) and half the width of an adult hand (Wtotal/2). All the 1 year-old children had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among the children aged 2 years, 6 (60.0%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among those aged 3 years, 4 (26.7%) had Stotal/2~X and Stotal/2~D less than Wtotal/2, and among those aged 4 years, 2 (13.3%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. However, Stotal/2~X and Stotal/2~D were greater than Wtotal/2 in children aged 5 years or more. We knew that small children may be at an increased risk of intra-thoracic trauma during 'one-handed' chest compressions.

Keywords: Cardiopulmonary resuscitation, child, compression.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1080312

References:

[1] Nadkarni V, Hazinski MF, Zideman D, et al. Paediatric life support: an advisory statement by the Paediatric Life support Working Group of the International Liaison committee on Resuscitation. Resuscitation 1997;34:115-27.
[2] Mogayzel C, Quan L, Graves Jr., et al. Out-of-hospital ventricular fibrillation in children and adolescents: causes and outcomes. Ann Emerg Med 1995;25:484-91.
[3] Kyriacou DN, Arcinue EL, Peek C, et al. Effect of immediate resuscitation on children with submersion injury. Pediatrics 1994;94:137-42.
[4] Hickey RW, Cohen DM, Strasbaugh S, et al. Pediatric patients requiring CPR in the prehospital setting. Ann Emerg Med 1995;25:495-501.
[5] Berg RA, Kern KB, Hilwig RW, et al. Assisted ventilation does not improve outcome in a porcine model of single-rescuer bystander cardiopulmonary resuscitation. Circulation 1997;95:1635-41.
[6] Berg RA, Sanders AB, Kern KB, et al. Adverse effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Circulation 2001; 104:2465-70.
[7] Berkowitz ID, Gervais H, Schleien CL, et al. Epinephrine dosage effects on cerebral and myocardial blood flow in an child swine model of cardiopulmonary resuscitation. Anesthesiology 1991;75:1041-50.
[8] 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 13. Pediatric basic life support. Circulation 2010;122:S862-75.
[9] Orlowski JP. Optimum position for external cardiac compression in children and young children. Ann Emerg Med 1986;15:667-73.
[10] Hoke RS, Chamberlain D. Skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation 2004;63:327-38.
[11] Thaler MM, Stobie GHC. An improved technique of external cardiac compression in infants and young children. N Engl J Med 1963;269:606-10.
[12] Thaler MM, Krause VW. Serious trauma in children after external cardiac massage. N Engl J Med 1962;267:500.
[13] Bush CM, Jones JS, Cohle SD, et al. Pediatric injuries from cardiopulmonary resuscitation. Ann Emerg Med 1996;28:40-4.