• Yoo Seok Park, Incheol Park, Young Jin Kim, Tae Nyoung Chung, Sun Wook Kim, Min Joung Kim, Sung Phil Chung, and Hahn Shick Lee.
• Department of Emergency Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, 120-752 Seoul, Republic of Korea.
• Resuscitation. 2011 Aug 1;82(8):1030-5.

ObjectiveThere has been little investigation on the appropriateness of the hand position suggested by various guidelines in paediatric cardiopulmonary resuscitation (CPR). We aimed to identify anatomical structures underneath the chest compression landmarks and tried to find the proper hand position using computed tomography (CT) images for more effective paediatric CPR.Patients And MethodsThis study included a total of 181 paediatric patients who were admitted to Severance Hospital and underwent CTs of chest. We studied structures located under the inter-nipple line and under the lower third of the sternum. The distances from the xiphoid process to the level of the left ventricular outflow tract (LVOT) were measured to find the ceiling on the proper hand position.ResultsThe LVOT (42.0%) and the root of the aorta (21.5%) were more frequently located than the left ventricle under the inter-nipple line, and the liver was located under the lower third of the sternum in a significant number of patients (28.7%). The LVOT was placed 6.8±13.9 mm below the nipple level, but there was no significant difference in the distance from the nipple level to the LVOT among the age groups (p=0.517).ConclusionsThe hand position at the inter-nipple line might be too high and that at the lower third of the sternum might be too low as it can compress the liver. Further studies are needed to find the proper hand position for more effective chest compression during paediatric CPR.Copyright © 2011. Published by Elsevier Ireland Ltd.

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