The Optimal Chest Compression Site during

Cardiopulmonary Resuscitation in Prone Position

서울대학교병원 마취통증의학과

권민지, 오혜원, 김은희, 송인경, 이지현, 김희수, 김진태

 Table of Contents

 Background
 Method
 Result
 Conclusion
 Background

 The prone position is used in many clinical situations

 Various orthopedic and neurosurgical procedure

 Some surgical procedure have a risk of cardiac arrest

 Turning the patient to supine position for CPR(Cardiopulmonary resuscitation)
may not be possible d/t operating field
 Background

 Optimal site for cardiac compression in the supine position in adults

“Lower half
of the
sternum”
 Background

 Optimal site for cardiac compression in the prone position ?

Where?
Where?
Where?
 Background

 According to “Cardiac pump theory”

 Compression of the largest area of left ventricle generate maximal cardiac
output

 Many previous studies used CT images for optimal cardiac compression site
 Background

 The purpose of this study:

 To determine the proper hand position level on the back to generate the
maximal cardiac output during CPR in the prone position

 by analyzing CT images taken in prone position

 Methods

 The prone chest CT images of 100 patient were reviewed retrospectively

 Exclusion criteria
 Hx of cardiothoracic surgery, spinal surgery, chest wall deformity, and poor CT
image quality
Methods

Posterior

Anterior
 Methods

 Each anatomic level was determined using the corresponding vertebral body

y
 Results

 Among 100 prone chest CT images reviewed,

 54 males, 46 females

 Mean age 63± 12 years

 Mean weight 60.0± 10.1 kg

 Mean height 160.3± 7.7 cm

 Results

 The organ structures beneath the anatomic landmarks

x:y≒2:3
∴ Largest cross-sectional LV
area was the lower third
(67± 7) %

177± 35 mm (x)
266± 42 mm (y)
 Results

The vertebral levels of the largest LV cross-sectional area corresponded to one vertebral
level below the inferior angle of the scapular (T8-T9 level)
 Results

 The organ structures beneath the anatomic landmarks

 Discussion

 The optimal cardiac compression level during CPR in the prone position
 One vertebral level below the line crossing both the inferior angles of the
scapula

 where the LV cross-sectional area is the largest in the prone position

→ This corresponds to the lower third of the length from the C7 spinous process
to the T12 spinous process
 Discussion

 If the surgical field includes the spinal column

 open wound, some protruding metal devices

 the two-handed bilateral back compression

technique is preferred
Thank you for listening!