What is the potential for over-compression using current paediatric chest compression guidelines? — A chest computed tomography study

AIM: We explored the potential for over-compression from current paediatric chest compression depth guidelines using chest computed tomography(CT) images of a large, heterogenous, Asian population. METHODS: A retrospective review of consecutive children, less than 18-years old, with chest CT images performed between from 2005 to 2017 was done. Demographic data were extracted from the electronic medical records. Measurements for internal and external anterior-posterior diameters (APD) were taken at lower half of the sternum. Simulated chest compressions were performed to evaluate the proportion of the population with residual internal cavity dimensions less than 0 mm (RICD < 0 mm, representing definite over-compression; with chest compression depth exceeding internal APD), and RICD less than 10 mm (RICD < 10 mm, representing potential over-compression). RESULTS: 592 paediatric chest CT studies were included for the study. Simulated chest compressions of one-third external APD had the least potential for over-compression; no infants and 0.3% children had potential over-compression (RICD < 10 mm). 4 cm simulated chest compressions led to 18% (95% CI 13%–24%) of infants with potential over-compression, and this increased to 34% (95% CI 27%–41%) at 4.4 cm (upper limit of “approximately” 4 cm; 4 cm + 10%). 5 cm simulated compressions resulted in 8% (95% CI 4%–12%) of children 1 to 8-years-old with potential over-compression, and this increased to 22% (95% CI 16%–28%) at 5.5 cm (upper limit of “approximately” 5 cm, 5 cm + 10%). CONCLUSION: In settings whereby chest compression depths can be accurately measured, compressions at the current recommended chest compression of approximately 4 cm (in infants) and 5 cm (in young children) could result in potential for over-compression.