• Matthew S Braga, Troy E Dominguez, Avrum N Pollock, Dana Niles, Andrew Meyer, Helge Myklebust, Jon Nysaether, and Vinay Nadkarni.
• Division of Pediatric Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA. matthew.s.braga@hitchcock.org
• Pediatrics. 2009 Jul 1;124(1):e69-74.

ObjectivePediatric consensus-driven cardiopulmonary resuscitation guidelines target chest compression (CC) depths of one third to one half anterior-posterior (AP) chest depth. Estimates for this target as assessed by computed tomography (CT) measurements of internal and external AP chest dimensions could direct future pediatric cardiopulmonary resuscitation guidelines.MethodsA total of 280 consecutive chest CT scans in permuted blocks of 20 for each of 14 age divisions between 0 and 8 years were reconstructed and analyzed. External and internal AP depths were measured at midsternum, and residual chest depth was calculated at simulated one-third and one-half AP compressions.ResultsAfter a simulated compression calculation, one-half external AP depth CC would result in residual internal depth of <10 mm for 94% (263 of 280) of children 3 months to 8 years. For a one-third external AP CC, only 0.4% (1 of 280) of children 3 months to 8 years had a calculated residual internal chest depth <10 mm.ConclusionsBy using CT reconstruction estimates of chest dimensions across the developmental spectrum from 0 to 8 years of age, we demonstrated that a simulated CC targeting approximately one-third external AP chest depth seems radiographically appropriate for children aged 3 months to 8 years, whereas simulated CC targeting approximately one-half external AP chest depth seems radiographically to be too deep, resulting in residual internal chest depth of <10 mm for most patients of this age.

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