• Daniel M Rolston, Daniel Jafari, Ghania Haddad, Xueqi Huang, Alaina Berruti, Kevin Frank, Nicholas Bielawa, Timmy Li, Lance B Becker, and Allison L Cohen.
• Northwell, New Hyde Park, New York, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States. Electronic address: drolston@northwell.edu.
• Resuscitation. 2024 Dec 12; 206: 110466110466.

IntroductionLimited evidence supports guidelines to perform chest compressions at the lower half of the sternum. Imaging studies suggest this location may obstruct blood flow. Our primary aim was to compare the highest arterial line systolic blood pressure (SBP) during lower-half-of-sternum chest compressions (CC) versus those left-of-sternum, where the left ventricle is more likely located. Secondarily, we compared the highest end-tidal CO2 (ETCO2).MethodsWe conducted a retrospective cohort study of video-recorded, adult Emergency Department (ED) cardiac arrest resuscitations where changes in CC location were attempted to improve physiologic parameters (SBP, ETCO2). We excluded epigastric and right-of-sternum compressions. Four CC zones were analyzed: recommended lower-half-of-sternum; left of lower-half-of-sternum; high left lateral; low left lateral. We combined all left-of-sternum compressions for analysis using linear mixed-effects models and multivariable mixed-effects controlling for manual vs. mechanical CCs.ResultsAmong 24 patients analyzed, 20 (83.3 %) had initial compressions at the lower-half-of-sternum. 11 patients had 28 lower-half-of-sternum and 32 left-of-sternum CC intervals with available SBPs. In the mixed-effects model, least squares mean (LSMean) SBP was higher with left-of-sternum CCs (108.5 mmHg [95 % CI 88.3-128.8 mmHg]) versus lower-half-of-sternum CCs (66.7 mmHg [95 % CI 46.5-86.9 mmHg], p < 0.001). 18 patients had 44 lower-half-of-sternum and 32 left-of-sternum CC intervals with available ETCO2. In the mixed-effects model, LSMean ETCO2 was similar at the lower-half-of-sternum (20.4 mmHg [95 % CI 16.0-24.9 mmHg]) and left-of-sternum (22.6 mmHg [95 % CI 17.6-27.6 mmHg], p = 0.300). Results were similar when controlling for manual vs. mechanical CCs.ConclusionsIn our pilot, retrospective, observational study of select ED cardiac arrest patients, left-of-sternum chest compressions are associated with higher SBP than lower-half-of-sternum compressions, while ETCO2 was similar.Copyright © 2024 Elsevier B.V. All rights reserved.

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