Estimation of optimal pediatric chest compression depth by using computed tomography

Objective This study aimed to compare the optimal chest compression depth for infants and children with that of adults when the simulated compression depth was delivered according to the current guidelines. Methods A total of 467 consecutive chest computed tomography scans (93 infants, 110 children, and 264 adults) were reviewed. The anteroposterior diameter and compressible diameter (CD) for infants and children were measured at the inter-nipple level and at the mid-lower half of the spine for adults. Compression ratio (CR) to CD was calculated at simulated 1/4, 1/3, and 1/2 antero-posterior compressions in infants and children, and simulated 5-and 6-cm compressions in adults. Results In adults, the CRs to CD at simulated 5-and 6-cm compression depth were 41.7+/-0.16%, 50.0+/-7.3% respectively. In children and infants, the CRs to CD at 1/3 chest compression were 55.1+/-2.4% and 51.8+/-2.4%, respectively, and at 1/2 chest compression, CRs were 82.7+/-3.7% and 77.7+/-3.6%, respectively. The CRs to CD of 4-cm compression depth in infants and 5-cm compression depth in children were 74.4+/-10.9%, 62.5+/-8.7%, respectively. The CRs to CD for children and infants were significantly higher than in adults (P<0.001). The CR to CD of 4-cm compression depth in children was almost similar to that of 6-cm compression depth in adults (50.0+/-6.9% vs. 50.0+/-7.3%, P=0.985). Conclusion Current pediatric guidelines for compression depth are too deep compared to those in adults. We suggest using 1/3 of the anteroposterior chest diameter or about 4 cm in children and less than 4 cm in infants.