Radiological assessment of chest compression point and achievable compression depth in cardiac patients

BACKGROUND: Using magnetic resonance imaging (MRI) to relate cardiovascular structures to surface anatomy in a population relevant to cardiac arrest victims, relate the external thoracic anterior-posterior (AP) diameter (AP(EXTERNAL)) and blood-filled structures to recommended chest compression depths, and define an optimal compression point (OCP). METHODS: MRI axial scans of referred patients were analysed. We defined origo as the skin surface of the centre of sternum in the internipple line. The blood-filled structures beneath origo were identified and the sum of their inner diameters (AP(BLOOD)) and AP(EXTERNAL) were measured. We defined OCP based on the image with maximum compressible left and right ventricle and where LVOT was not present. We measured the distance from origo to OCP. RESULTS: Consecutive patients, mean (SD), age 52 (17) years, 110 (76 %) males, were categorized: cardiac disease (n = 74), aortic disease (n = 13), no findings/study patient (included in another study) (n = 57). The structure LVOT/aortic valve (AV)/aortic root was present in 46 % of patients with cardiac disease vs. 19 % of patients with no findings. AP(EXTERNAL) for males and females was 25 (2) cm and 22 (2) cm, and AP(BLOOD) 6.5 cm (2) and 4.7 cm (2), respectively. Distance from origo to OCP was 32 (11) mm to the left and 16 (21) mm caudally. DISCUSSION: LVOT/AV/aortic root was present beneath the origo in almost half the patients with cardiac disease. Recommended chest compression depths exceeded the anterior-posterior diameter of blood-filled structures in more than half of the females. OCP was found 3 cm left of the origo. CONCLUSIONS: Based on our study, individualized compression point and depth could be further studied in a prospective, clinical study. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13049-016-0245-0) contains supplementary material, which is available to authorized users.