|
KMID : 1100620190060040303
|
|
Clinical and Experimental Emergency Medicine
2019 Volume.6 No. 4 p.303 ~ p.313
|
|
|
Determination of the theoretical personalized optimum chest compression point using anteroposterior chest radiography
|
|
Kim Shin-Woo
Chon Sung-Bin
Oh Won-Sup
Cho Sun-Ho
|
|
|
Abstract
|
|
|
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=α0*CD-RB; y_max.LV=β0*CH+γ0 (α0: mean of [x_max.LV+RB]/CD; β0, γ0: 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.
|
|
|
KEYWORD
|
|
|
Cardiopulmonary resuscitation, Heart arrest, Intensive care units, Radiography, thoracic, Tomography, X-ray computed
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
 
|
|