Where is the left ventricle during cardiopulmonary resuscitation based on chest computed tomography in the expiration with arms down position?

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Abstract

Objective Patients usually receive cardiopulmonary resuscitation during ventilatory expiration and with their arms down, which does not reflect the normal imaging position. This study used scout images from low-dose chest computed tomography to compare the locations of the left ventricle (LV) in the expiration with arms down position (EAD) and in the full inspirational with arms raised position (IAR). Methods This cross-sectional study used a convenience sample and evaluated scout images that were obtained during screening with the participants in the EAD and IAR positions. The effective compression point was defined as being on the sternum above the longest anteroposterior diameter (APD) of the LV (using axial computed tomography images). The sternum was divided into three parts and the heart’s position was evaluated on the EAD and the IAR images, and the distance from the xiphoid process to the LV’s sternum landmark (XLVD) was measured. We also examined the compressible organs during CPR based on the EAD and IAR images. Results We enrolled 127 participants. The LVs were located in the middle of the sternum at EAD for 117 participants (92%) and in the lower half of the sternum at IAR for 107 participants (84%). The mean XLVD was significantly different between the EAD and IAR positions (mean: 85 ± 21 mm vs. 33 ± 17 mm, respectively). The liver’s left lobe was located in the lower half of the sternum at EAD for 118 participants (93%). Conclusions These findings indicate that the location of the LV during cardiopulmonary resuscitation might be in the middle of the sternum if the patient is treated in the EAD position.

Original languageEnglish
Article numbere0193364
JournalPLoS ONE
Volume13
Issue number2
DOIs
StatePublished - Feb 2018

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cardiopulmonary resuscitation
Resuscitation
electroantennography
Sternum
Cardiopulmonary Resuscitation
sternum
chest
computed tomography
Heart Ventricles
Tomography
Arm
Thorax
Liver
Screening
Imaging techniques
Xiphoid Bone
cross-sectional studies
Cross-Sectional Studies
heart
image analysis

Cite this

@article{3a052e20ee764837b13da40c4a39d60a,
title = "Where is the left ventricle during cardiopulmonary resuscitation based on chest computed tomography in the expiration with arms down position?",
abstract = "Objective Patients usually receive cardiopulmonary resuscitation during ventilatory expiration and with their arms down, which does not reflect the normal imaging position. This study used scout images from low-dose chest computed tomography to compare the locations of the left ventricle (LV) in the expiration with arms down position (EAD) and in the full inspirational with arms raised position (IAR). Methods This cross-sectional study used a convenience sample and evaluated scout images that were obtained during screening with the participants in the EAD and IAR positions. The effective compression point was defined as being on the sternum above the longest anteroposterior diameter (APD) of the LV (using axial computed tomography images). The sternum was divided into three parts and the heart’s position was evaluated on the EAD and the IAR images, and the distance from the xiphoid process to the LV’s sternum landmark (XLVD) was measured. We also examined the compressible organs during CPR based on the EAD and IAR images. Results We enrolled 127 participants. The LVs were located in the middle of the sternum at EAD for 117 participants (92{\%}) and in the lower half of the sternum at IAR for 107 participants (84{\%}). The mean XLVD was significantly different between the EAD and IAR positions (mean: 85 ± 21 mm vs. 33 ± 17 mm, respectively). The liver’s left lobe was located in the lower half of the sternum at EAD for 118 participants (93{\%}). Conclusions These findings indicate that the location of the LV during cardiopulmonary resuscitation might be in the middle of the sternum if the patient is treated in the EAD position.",
author = "Hyuksool Kwon and Kim, {Yeo Goon} and Kyuseok Kim and Jung, {Jae Yun} and Joonghee Kim and Sangil Choi and Chun, {Eun Ju} and Bae, {Woo Kyung}",
year = "2018",
month = "2",
doi = "10.1371/journal.pone.0193364",
language = "English",
volume = "13",
journal = "PloS one",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "2",

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TY - JOUR

T1 - Where is the left ventricle during cardiopulmonary resuscitation based on chest computed tomography in the expiration with arms down position?

AU - Kwon, Hyuksool

AU - Kim, Yeo Goon

AU - Kim, Kyuseok

AU - Jung, Jae Yun

AU - Kim, Joonghee

AU - Choi, Sangil

AU - Chun, Eun Ju

AU - Bae, Woo Kyung

PY - 2018/2

Y1 - 2018/2

N2 - Objective Patients usually receive cardiopulmonary resuscitation during ventilatory expiration and with their arms down, which does not reflect the normal imaging position. This study used scout images from low-dose chest computed tomography to compare the locations of the left ventricle (LV) in the expiration with arms down position (EAD) and in the full inspirational with arms raised position (IAR). Methods This cross-sectional study used a convenience sample and evaluated scout images that were obtained during screening with the participants in the EAD and IAR positions. The effective compression point was defined as being on the sternum above the longest anteroposterior diameter (APD) of the LV (using axial computed tomography images). The sternum was divided into three parts and the heart’s position was evaluated on the EAD and the IAR images, and the distance from the xiphoid process to the LV’s sternum landmark (XLVD) was measured. We also examined the compressible organs during CPR based on the EAD and IAR images. Results We enrolled 127 participants. The LVs were located in the middle of the sternum at EAD for 117 participants (92%) and in the lower half of the sternum at IAR for 107 participants (84%). The mean XLVD was significantly different between the EAD and IAR positions (mean: 85 ± 21 mm vs. 33 ± 17 mm, respectively). The liver’s left lobe was located in the lower half of the sternum at EAD for 118 participants (93%). Conclusions These findings indicate that the location of the LV during cardiopulmonary resuscitation might be in the middle of the sternum if the patient is treated in the EAD position.

AB - Objective Patients usually receive cardiopulmonary resuscitation during ventilatory expiration and with their arms down, which does not reflect the normal imaging position. This study used scout images from low-dose chest computed tomography to compare the locations of the left ventricle (LV) in the expiration with arms down position (EAD) and in the full inspirational with arms raised position (IAR). Methods This cross-sectional study used a convenience sample and evaluated scout images that were obtained during screening with the participants in the EAD and IAR positions. The effective compression point was defined as being on the sternum above the longest anteroposterior diameter (APD) of the LV (using axial computed tomography images). The sternum was divided into three parts and the heart’s position was evaluated on the EAD and the IAR images, and the distance from the xiphoid process to the LV’s sternum landmark (XLVD) was measured. We also examined the compressible organs during CPR based on the EAD and IAR images. Results We enrolled 127 participants. The LVs were located in the middle of the sternum at EAD for 117 participants (92%) and in the lower half of the sternum at IAR for 107 participants (84%). The mean XLVD was significantly different between the EAD and IAR positions (mean: 85 ± 21 mm vs. 33 ± 17 mm, respectively). The liver’s left lobe was located in the lower half of the sternum at EAD for 118 participants (93%). Conclusions These findings indicate that the location of the LV during cardiopulmonary resuscitation might be in the middle of the sternum if the patient is treated in the EAD position.

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