Should paediatric chest compression depth targets consider body habitus? - A chest computed tomography imaging study

Gene Yong-Kwang Ong; Aloysius Jian Feng Ang; Zhao Jin Chen; Yiong Huak Chan; Phua Hwee Tang; Elisabeth Sue Sheun Fong; Jun Yuan Tan; AmirZeb S O Aurangzeb; Jen Heng Pek; Ian Maconochie; Kee Chong Ng; Vinay Nadkarni

doi:10.1016/j.resplu.2022.100202

Should paediatric chest compression depth targets consider body habitus? - A chest computed tomography imaging study

Resusc Plus. 2022 Jan 20:9:100202. doi: 10.1016/j.resplu.2022.100202. eCollection 2022 Mar.

Authors

Affiliations

¹ Children's Emergency, KK Women's and Children's Hospital, Singapore.
² Duke-NUS Medical School, Singapore.
³ Biostatistics Unit, National University of Singapore, Singapore.
⁴ Department of Diagnostic Imaging, KK Women's and Children's Hospital, Singapore.
⁵ Department of Emergency Medicine, Sengkang General Hospital, Singapore.
⁶ Accident and Emergency Service, St Mary's Hospital, London, United Kingdom.
⁷ Department of Medicine, Imperial College, Kensington, London, United Kingdom.
⁸ Center for Pediatric Resuscitation, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, United States of America.

Abstract

Aim: This study explored how body habitus in the paediatric population might potentially affect the use of one-third external anterior-posterior (APD) diameter when compared to age-appropriate absolute chest compression depth targets. It also explored how body habitus could potentially affect the relationship between one-third external and internal APD (compressible space) and if body habitus indices were independent predictors of internal APD at the lower half of the sternum.

Methods: This was a secondary analysis of a retrospective study of chest computed tomography (CT) scans of infants and children (>24-hours-of-life to less-than-18-years-old) from 2005 to 2017. Patients' scan images were reviewed for internal and external APDs at the mid-point of the lower half of the sternum. Body habitus and epidemiological data were extracted from the electronic medical records.

Results: Chest CT scans of 193 infants and 398 children were evaluated. There was poor concordance between one-third external APD measurements and age-specific absolute chest compression depth targets, especially in infants and overweight/obese adolescents. There was a co-dependent relationship between one-third external APD and internal APD measurements. Overweight/obese children's and adolescents' internal and external APDs were significant different from the normal/underweight groups. Body-mass-index (BMI) of children and adolescents (p = 0.009), but not weight-for-length (WFL) of infants (p = 0.511), was an independent predictor of internal APD at the compression landmark.

Conclusion: This study demonstrated correlations between external and internal APDs which were affected by BMI but not WFL (infants). Clinical studies are needed to validate current chest compression guidelines especially for infants and overweight/obese adolescents.(250 words).

Keywords: APD, anterior-posterior diameter; Anthropometry; BMI, body mass index; CI, confidence interval; CT, computed tomography; Cardiopulmonary resuscitation; Chest compressions; Computed tomography; Paediatrics; SD, standard deviation; WFL, weight-for-length; WHO, World Health Organisation.