Theoretical personalized optimum chest compression point can be determined using posteroanterior chest radiography

Autor: Sung-Bin Chon, Won Sup Oh, Keunha Hwang, Shin Woo Kim, Sunho Cho
Rok vydání: 2018
Předmět:
Male
Sternum
Radiography
medicine.medical_treatment
Heart Ventricles
Computed tomography
Xiphisternal joint
Heart Massage
030204 cardiovascular system & hematology
Emergency Nursing
03 medical and health sciences
0302 clinical medicine
Imaging
Three-Dimensional
Maximum diameter
Cardiac border
Medicine
Humans
Cardiopulmonary resuscitation
Precision Medicine
Aged
Retrospective Studies
medicine.diagnostic_test
business.industry
030208 emergency & critical care medicine
Heart
Stroke volume
Middle Aged
Thorax
Compression (physics)
Cardiopulmonary Resuscitation
medicine.anatomical_structure
Cross-Sectional Studies
Practice Guidelines as Topic
Emergency Medicine
Linear Models
Female
Cardiology and Cardiovascular Medicine
business
Nuclear medicine
Tomography
X-Ray Computed
Out-of-Hospital Cardiac Arrest
Zdroj: Resuscitation. 128
ISSN: 1873-1570
Popis: Aim Cardiopulmonary resuscitation guidelines suggest the lower sternal half be compressed. However, stroke volume has been assumed to be maximized by compressing the ‘point’ (P_max.LV) beneath which the left ventricle (LV) is at its maximum diameter. Identifying ‘personalized’ P_max.LV on computed tomography (CT), we derived and validated rules to estimate P_max.LV using posteroanterior chest radiography (chest_PA). Methods A retrospective, cross-sectional study was performed with non-cardiac arrest (CA) adults who underwent chest_PA and CT within 1h (derivation:validation = 3:2). On chest_PA, we defined CD (cardiac diameter), RB (distance from right cardiac border to midline) and CH (cardiac height, from carina to uppermost point of left hemi-diaphragm). Setting P_zero (0, 0) at the midpoint of 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). Mathematically, followings were inferable: x_max.LV = α0*CD-RB; y_max.LV = s0*CH + γ0. (α0: mean of (x_max.LV + RB)/CD; s0, γ0: representative coefficient and constant of linear regression model, respectively). We investigated their feasibility by applying them to in-hospital (IHCA) and out-of-hospital CA (OHCA) adults. RESULTS Among 266 (57.6 ± 16.4 years, 120 females), followings were derived: x_max.LV = 0.664*CD-RB; y_max.LV = 40 − 0.356*CH. Estimated P_max.LV was closer to the reference than other candidates and thus validated: 15 ± 9 vs 17 ± 10 (averaged P_max.LV, p = 0.025); 76 ± 13, 54 ± 11 and 63 ± 13 mm (3 equidistant points as per guidelines, all p CONCLUSION Personalized P_max.LV, which is potentially superior to the lower sternal half and feasible in CA, is estimable with chest_PA.
Databáze: OpenAIRE
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