scholarly journals The optimal chest compression point on sternum based on chest-computed tomography: A retrospective study

2019 ◽  
Vol 27 (4) ◽  
pp. 197-201
Author(s):  
Libing Jiang ◽  
Jie Min ◽  
Fan Yang ◽  
Xiaotong Shao
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Chest Compression ◽  
Left Ventricular ◽  
Current Guideline ◽  
Adult Health ◽  
Median Length ◽  
High Quality ◽  
Left Ventricular Diameter ◽  
Chest Computed Tomography

Background: High-quality chest compression is crucial for cardiac arrest patients. However, only few studies are focusing on the optimal compression point. Objective: The aim of this study was to explore the optimal compression point based on chest-computed tomography. Methods: We retrospectively selected 166 adult health subjects between January 2018 and May 2018 in a university-affiliated hospital. Results: The median length of sternum was 14.9 cm. The median length from the inter-nipple line to the distal end of sternum was 1.0 cm. The median length from the point at which the maximal left ventricular diameter projected onto the sternum to the distal end of the sternum was −1.4 (–2.2 to 0.0) cm. The median value of the length from the inter-nipple line to the distal end of sternum plus the length from the point at which the maximal left ventricular diameter projected onto the sternum to the distal end of the sternum was 2.0 (1.0–3.1) cm. Conclusion: One size does not fit all. The point recommended by the current guideline may not appropriate for Chinese person. Further studies are required focusing on individual chest compression during cardiopulmonary resuscitation.

scholarly journals Current Guideline of Chest Compression Depth for Children of All Ages May Be Too Deep for Younger Children

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Jang Hee Lee ◽  
Sang Kuk Han ◽  
Ji Ung Na
Keyword(s):  
Computed Tomography ◽  
Chest Compression ◽  
Age Groups ◽  
Adult Patients ◽  
Current Guideline ◽  
Compression Depth ◽  
Chest Computed Tomography ◽  
Pediatric Resuscitation ◽  
Resuscitation Guidelines ◽  
The Mean

Aim. To determine whether the chest compression depth of at least 1/3 of the Anteroposterior (AP) diameter of the chest and about 5 cm is appropriate for children of all age groups via chest computed tomography. Methods. The AP diameter of the chest, anterior chest wall diameter, and compressible diameter (Cd) were measured at the lower half of the sternum for patients aged 1-18 years using chest computed tomography. The mean ratio of 5 cm compression to the Cd of adult patients was used as the lower limit, and the mean ratio of 6 cm compression to the Cd of adult patients was used as the upper limit. Also, the depth of chest compression resulting in a residual depth <1 cm was considered to cause internal injury potentially. With the upper and lower limits, the compression ratios to the Cd were compared when compressions were performed at a depth of 1/3 the AP diameter of the chest and 5 cm for patients aged 1-18 years. Results. Among children aged 1-7 years, compressing 5 cm was deeper than 1/3 the AP diameter. Also, among children aged 1-5 years, 5 cm did not leave a residual depth of 1 cm, potentially causing intrathoracic injury. Conclusion. Current pediatric resuscitation guidelines of chest compression depth for children were too deep for younger children aged 1-7 years.

Abstract 13721: The Monitoring of rSO2 Value During CPR is Useful for High-Quality CPR

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yoshihito Ogawa ◽  
Tadahiko Shiozaki ◽  
Tomoya Hirose ◽  
Mitsuo Ohnishi ◽  
Goro Tajima ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Clinical Utility ◽  
Spontaneous Circulation ◽  
Regional Cerebral Oxygen Saturation ◽  
High Quality ◽  
Specificity And Sensitivity ◽  
Single Center Study ◽  
Manual Chest Compression ◽  
Hospital Cardiac Arrest

[Background] Recently, the patients with out-of-hospital cardiac arrest are increasing. It is very important to do chest compression continuously for the return of spontaneous circulation (ROSC). But we can not but stop chest compression during checking pulse every few minutes. We reported that Regional cerebral Oxygen Saturation (rSO2) value was not elevated by manual chest compression and mechanical chest compression increased a little rSO2 value on CPR without ROSC and rSO2 value became a good parameter of ROSC in single center study. [Purpose] The purpose of this study is to evaluate clinical utility of rSO2 value during CPR in multicenter study. [Method] Retrospectively, we considered the rSO2 value of the out-of -hospital cardiac arrest patients from December 2012 to December 2014 in multicenter. During CPR, rSO2 were recorded continuously from the forehead of the patients by TOS-OR (Japan). CPR for patients with OHCA was performed according to the JRC-guidelines 2010. [Result] 252 patients with OHCA were included in this study. The rSO2 value on arrival, during CPR and ROSC were 44.4±8.9%, 45.4±9.7%, 58.6±9.2%. In ROSC, with rSO2 cutoff value of 52.7%, the specificity and sensitivity were 80% and 79%, respectively. The negative predict value was 99.2%, respectively. It means little possible to ROSC, if the rSO2 value is less than 52.7%. So, it may be possible to reduce the frequency of checking pulse during CPR. [Conclusion] The monitoring of rSO2 value could reduce the frequency of checking pulse during CPR and do chest compression continuously.

Abstract 365: Left Ventricular Wall Findings in Non-Electrocardiography-Gated Contrast-Enhanced Computed Tomography After Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Kazuhiro Sugiyama ◽  
Kazuki Miyazaki ◽  
Takuto Ishida ◽  
Takahiro Tanabe ◽  
Yuichi Hamabe
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Hospital Discharge ◽  
Left Ventricular ◽  
Left Ventricular Wall ◽  
Ventricular Wall ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Significant Stenosis ◽  
Contrast Enhanced

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory cardiac arrest. Computed tomography (CT) is often performed after ECPR for diagnosis of etiology and evaluation of complications. However, few studies have reported left ventricular wall findings in contrast-enhanced CT (CE-CT) after ECPR. This study examined the left ventricular wall CE-CT findings after ECPR, and evaluated the association between these findings and the results of coronary angiography and prognosis. Method: We evaluated out-of-hospital cardiac arrest patients who were treated with ECPR and then underwent both non-ECG gated CE-CT and coronary angiography at our center between January 2011 and April 2018. The left ventricular wall CE-CT findings at 90 s after contrast injection were classified as follows: homogeneously-enhanced (HE), left ventricular wall was homogeneously enhanced; segmental defect (SD), left ventricular wall was not segmentally enhanced according to coronary artery territory; total defect (TD), entire left ventricular wall was not enhanced; and others. Significant stenosis on coronary angiography, survival to hospital discharge, and successful weaning from extracorporeal membrane oxygenation (ECMO) were examined. Results: A total of 111 patients were eligible. Median age was 59 years, and 85 (77%) had initial shockable rhythm. A total of 37 (33%) survived to hospital discharge. HE was observed in 33 patients, SD in 41, TD in 15, and others in 22. Among 74 patients who underwent CT prior to coronary angiography, SD predicted significant stenosis, with sensitivity of 83% and specificity of 100%. Among all patients, 28 (85%) with HE, 15 (37%) with SD, and 3 (20%) with TD were weaned successfully from ECMO. In addition, 17 (52%) patients with HE, 10 (24%) with SD, and 2 (13%) with TD survived to hospital discharge. Conclusion: SD could predict coronary artery stenosis with good specificity. Patients with HE had higher success rates for weaning from ECMO. On the other hand, TD was associated with poor outcomes. The left ventricular wall findings in non-ECG gated CE-CT after ECPR might be useful in diagnosis and prognostication.

Abstract 87: Cyclosporin A does not Prevent Myocardial Dysfunction after Resuscitation from Cardiac Arrest in Rats

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Iyad M Ayoub ◽  
Jeejabai Radhakrishnan ◽  
Raúl J Gazmuri
Keyword(s):  
Cardiac Arrest ◽  
Cyclosporin A ◽  
Chest Compression ◽  
Rat Model ◽  
Mitochondrial Permeability Transition ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
List Type ◽  
Ischemia And Reperfusion ◽  
Biphasic Waveform

Objective: We have previously reported in a rat model of VF and closed-chest resuscitation that cytochrome c is released into the bloodstream after resuscitation from cardiac arrest attaining plasma levels inversely proportional to survival. Recent evidence indicates that release of cytochrome c during ischemia and reperfusion may be a manifestation of prolonged opening of the mitochondrial permeability transition pore (mPTP). In this study, we investigated whether cyclosporin A (CsA, an inhibitor of mPTP opening) can prevent post-resuscitation (PR) myocardial dysfunction and improve survival. Methods: VF was electrically induced and left untreated for 10 mins. Resuscitation was attempted by 8 mins of chest compression followed by biphasic waveform defibrillation. Rats were randomized to received a bolus CsA (10 mg/kg) five minutes before inducing VF (n=6), immediately before starting chest compression (n=6), or to receive vehicle control before inducing VF (n=3) or before starting chest compression (n=3). CsA-treated (n=12) and vehicle-treated (n=6) rats were pooled for this analysis after noticing no differences between subgroups. Resuscitated rats were monitored for up to 6 hours. Results: All rats were successfully resuscitated. Treatment with CsA did not improve PR myocardial function (Table ). Survival time was comparable between CsA-treated (321±67 mins) and vehicle-treated (331±67 mins) rats. Conclusions: In our rat model of VF and resuscitation, CsA failed to prevent PR myocardial dysfunction and improve survival. These data contrast with numerous studies demonstrating a protective effect in isolated heart models of ischemia and reperfusion. Two possible explanations are the mPTP does not open in this unique setting of cardiac arrest and resuscitation, and the optimal in vivo dose of CsA needs to be determined as the protective effects of CsA are dose dependent. Hemodynamic and Left Ventricular Function

Computed tomography angiography with pulmonary artery thrombus burden and right-to-left ventricular diameter ratio after pulmonary embolism

Vascular ◽  
2016 ◽  
Vol 25 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Kenneth Ouriel ◽  
Richard L Ouriel ◽  
Yeun J Lim ◽  
Gregory Piazza ◽  
Samuel Z Goldhaber
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Computed Tomography Angiography ◽  
Intraclass Correlation ◽  
Left Ventricular ◽  
Observer Agreement ◽  
Left Ventricular Diameter ◽  
The Right

Purpose Computed tomography angiography is used for quantifying the significance of pulmonary embolism, but its reliability has not been well defined. Methods The study cohort comprised 10 patients randomly selected from a 150-patient prospective trial of ultrasound-facilitated fibrinolysis for acute pulmonary embolism. Four reviewers independently evaluated the right-to-left ventricular diameter ratios using the standard multiplanar reformatted technique and a simplified (axial) method, and thrombus burden with the standard modified Miller score and a new, refined Miller scoring system. Results The intraclass correlation coefficient for intra-observer variability was .949 and .970 for the multiplanar reformatted and axial methods for estimating right-to-left ventricular ratios, respectively. Inter-observer agreement was high and similar for the two methods, with intraclass correlation coefficient of .969 and .976. The modified Miller score had good intra-observer agreement (intraclass correlation coefficient .820) and was similar to the refined Miller method (intraclass correlation coefficient .883) for estimating thrombus burden. Inter-observer agreement was also comparable between the techniques, with intraclass correlation coefficient of .829 and .914 for the modified Miller and refined Miller methods. Conclusions The reliability of computed tomography angiography for pulmonary embolism was excellent for the axial and multiplanar reformatted methods for quantifying the right-to-left ventricular ratio and for the modified Miller and refined Miller scores for quantifying of pulmonary artery thrombus burden.

Does accelerometer feedback on high-quality chest compression improve survival rate? An in-hospital cardiac arrest simulation

2015 ◽  
Vol 33 (8) ◽  
pp. 993-997 ◽  
Author(s):  
Min Hee Jung ◽  
Je Hyeok Oh ◽  
Chan Woong Kim ◽  
Sung Eun Kim ◽  
Dong Hoon Lee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Chest Compression ◽  
High Quality ◽  
Improve Survival Rate ◽  
Hospital Cardiac Arrest

Transesophageal echocardiography in patients with cardiac arrest: from high-quality chest compression to effective resuscitation

2020 ◽  
Author(s):  
Emanuele Catena ◽  
Riccardo Colombo ◽  
Alessandra Volontè ◽  
Beatrice Borghi ◽  
Paola Bergomi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Transesophageal Echocardiography ◽  
Chest Compression ◽  
High Quality

Measuring Left Ventricular Size in Non–Electrocardiographic-gated Chest Computed Tomography

2018 ◽  
Vol 33 (2) ◽  
pp. 81-87 ◽  
Author(s):  
Felipe S. Torres ◽  
Luciano Folador ◽  
Diego A. Eifer ◽  
Murilo Foppa ◽  
Kate Hanneman
Keyword(s):  
Computed Tomography ◽  
Left Ventricular ◽  
Ventricular Size ◽  
Chest Computed Tomography ◽  
Left Ventricular Size

scholarly journals Severe multivessel coronary artery spasm detected by computed tomography: a case report

2020 ◽  
Author(s):  
Cai De Jin ◽  
Moo Hyun Kim ◽  
Su-A Jo ◽  
Kyunghee Lim
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Troponin I ◽  
Coronary Artery Spasm ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Inferior Wall ◽  
Total Occlusion ◽  
Ventricular Ejection Fraction

Abstract Background Ventricular arrhythmia and sudden cardiac arrest caused by multivessel coronary artery spasm (CAS) is rare. Although coronary angiography (CAG) with provocation testing is the diagnostic gold standard in current vasospastic angina guidelines, it can cause severe procedure-related complications. Here, we report a novel technique involving dual-acquisition coronary computed tomography angiography (CCTA) to detect multivessel CAS in a patient who survived out-of-hospital cardiac arrest (OHCA). Case summary A 58-year-old healthy Korean male survived OHCA caused by ventricular fibrillation (VF), experiencing seven episodes of defibrillation and cardiopulmonary resuscitation, and was referred to the Emergency Room. Vital signs were stable and physical examination, electrocardiogram, chest, and brain CT did not show any abnormal findings, except elevated hs-Troponin I levels (0.1146 ng/mL). Echocardiogram revealed a regional wall motion abnormality in the inferior wall, with a low normal left ventricular ejection fraction (50%). A multivessel CAS (both left and right) was detected using a dual-acquisition CCTA technique (presence and absence of intravenous nitrate). During CAG with the 2nd injection of ergonovine, a prolonged and refractory total occlusion in the proximal-ostial right coronary artery was completely relieved after a seven-cycle intracoronary injection regimen of nitroglycerine. The patient was discharged with the recommendation of smoking and alcohol cessation. Nitrate and calcium channel blockers were also prescribed. The patient had no further events at 3 months of follow-up after discharge. Discussion Dual-acquisition CCTA is a promising tool to detect multivessel CAS.

scholarly journals Cardiopulmonary Resuscitation Induced Consciousness - A Case Report in an Elderly Patient

2020 ◽  
Author(s):  
Joel Pinto ◽  
Paulo Almeida ◽  
Fani Ribeiro ◽  
Rita Simões
Keyword(s):  
Elderly Patient ◽  
Cardiac Arrest ◽  
Case Report ◽  
Cardiopulmonary Resuscitation ◽  
Male Patient ◽  
Chest Compression ◽  
Physical Restraint ◽  
High Quality ◽  
Spontaneous Movements

Cardiopulmonary resuscitation-induced consciousness is a rarely described and often misunderstood phenomenon, although it can be encountered. High quality cardiopulmonary resuscitation (CPR) may lead a patient to recover consciousness while in cardiac arrest. The authors present the case of an 89-year-old male patient who received CPR after a cardiac arrest. Spontaneous movements during CPR were noted and prompted several CPR interruptions. These movements immediately stopped during chest compression pauses. Physical restraint was used in order to be able to continue with the CPR algorithm, but sedation may be the best approach. Guidelines on how to identify and manage these cases need to be developed.

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