• Hyoungouk Kim, Sung-Bin Chon, Seung Min Yoo, Himchan Choi, and Kwang-Yeol Park.
• Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
• Acta Anaesthesiol Scand. 2020 Aug 1; 64 (7): 1002-1013.

BackgroundSome researchers have reported that applying compression closer to the maximum diameter of the left ventricle (Point_max.LV) is associated with worse clinical outcomes, challenging its traditional position as optimum compression point (Point_optimum). By locating the mid-sternum (the actual compression site) in terms of Point_max.LV and its right ventricular equivalent (Point_max.RV), we aimed to determine its optimum horizontal position associated with increased chances of return of spontaneous circulation (ROSC).MethodsA retrospective, cross-sectional study was performed at a university hospital from 2014 to 2019 on non-traumatic out-of-hospital cardiac arrest (OHCA) victims who underwent chest computed tomography. On absolute x-axis, we designated the x-coordinate of the mid-sternum (x_mid-sternum) as 0 and leftward direction as positive. Re-defining the x-coordinate of Point_max.RV and Point_max.LV as 0 and 1 interventricular unit (IVU), respectively, we could convert x_mid-sternum to "-x_max.RV/(x_max.LV - x_max.RV) (IVU)." Using multiple logistic regression analysis, we investigated whether this converted x_mid-sternum was associated with clinical outcomes, adjusting core elements of the Utstein template.ResultsAmong 887 non-traumatic OHCA victims, 124 [64.4 ± 16.7 years, 43 women (34.7%)] were enrolled. Of these, 80 (64.5%) exhibited ROSC. X_mid-sternum ranging from -1.71 to 0.58 (-0.36 ± 0.38) IVU was categorised into quintiles: <-0.60, -0.60 to -0.37, -0.37 to -0.22, -0.22 to -0.07 and ≥-0.07 (reference) IVU. The first quintile was positively associated with ROSC (odds ratio [95% confidence interval], 9.43 [1.44, 63.3]).ConclusionPoint_optimum might be located far rightwards to Point_max.RV, challenging the traditional assumption identifying Point_optimum as Point_max.LV.© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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