Determination of the theoretical personalized optimum chest compression point using anteroposterior chest radiography

초록

Objective There is a traditional assumption that to maximize stroke volume, the point beneath which the left ventricle (LV) is at its maximum diameter (P_max.LV) should be compressed. Thus, we aimed to derive and validate rules to estimate P_max.LV using anteroposterior chest radiography (chest_AP), which is performed for critically ill patients urgently needing determination of their personalized P_max.LV. Methods A retrospective, cross-sectional study was performed with non-cardiac arrest adults who underwent chest_AP within 1 hour of computed tomography (derivation:validation=3:2). On chest_AP, we defined cardiac diameter (CD), distance from right cardiac border to midline (RB), and cardiac height (CH) from the carina to the uppermost point of left hemi-diaphragm. Setting point zero (0, 0) at the midpoint of the xiphisternal joint and designating leftward and upward directions as positive on x-and y-axes, we located P_max.LV (x_max.LV, y_max.LV). The coefficients of the following mathematically inferred rules were sought: x_max.LV=α<inf>0</inf>*CD-RB; y_max.LV=β<inf>0</inf>*CH+γ<inf>0</inf> (α<inf>0</inf>: mean of [x_max.LV+RB]/CD; β<inf>0</inf>, γ<inf>0</inf>: representative coefficient and constant of linear regression model, respectively). Results Among 360 cases (52.0± 18.3 years, 102 females), we derived: x_max.LV=0.643*CD-RB and y_max.LV=55-0.390*CH. This estimated P_max.LV (19± 11 mm) was as close as the averaged P_max.LV (19± 11 mm, P=0.13) and closer than the three equidistant points representing the current guidelines (67± 13, 56± 10, and 77± 17 mm; all P<0.001) to the reference identified on computed tomography. Thus, our findings were validated. Conclusion Personalized P_max.LV can be estimated using chest_AP. Further studies with actual cardiac arrest victims are needed to verify the safety and effectiveness of the rule. © 2019 The Korean Society of Emergency Medicine.

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