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A3168
October 24, 2016
10/24/2016 3:15:00 PM - 10/24/2016 5:15:00 PM
Room Hall F Foyer-Area D
Optimizing Prone CPR: Identifying the Vertebral Level Correlating With the Largest LV Cross Sectional Area Via CT Scan
Ji-Hyun LEE, M.D., Eun-Hee Kim, M.D., In-Kyung Song, M.D., Sung Ae Jung, M.D., Hyongmin Oh, M.D., Jin-Tae Kim, Ph.D.
Seoul National University Hospital, Seoul, Korea, Republic of
Disclosures:  J. Lee: None. E. Kim: None. I. Song: None. S. Jung: None. H. Oh: None. J. Kim: None.
Background: The prone position is frequently required for some surgical procedures. If cardiac arrest occurs and the patient cannot be safely turned supine, cardiopulmonary resuscitation (CPR) may need to be performed in the prone position. Although clear landmarks have been defined for supine CPR, the optimal hand position for CPR in the prone position has not been clearly determined. The purpose of this study was to determine anatomically the optimal hand position for CPR in the prone position.

Methods: We retrospectively reviewed the chest computed tomography images of 100 patients taken in the prone position. The vertebral body levels crossing the medial angle of the scapula, the inferior angle of the scapula, and the spinous process of the vertebral body connected to the most inferior rib were identified, and we selected the image level at which the left ventricle (LV) cross-sectional area was the largest. This level was defined as the optimal compression level and correlated to surface anatomical landmarks. We calculated the ratio of the distance from the C7 spinous process to the level of the largest LV cross-sectional area divided by the distance from the C7 spinous process to the spinous process of the vertebral body connected with the most inferior rib.

Results: The level of the largest LV cross-sectional area in the prone position was one vertebral segment below the inferior angle of the scapula in 45% (99% CI: 33 to 58) of patients and 0-2 vertebral segments below that in 95% (99% CI: 86 to 98) of patients. The mean (SD) the ratio of the distance from the C7 spinous process to the level of the largest LV cross-sectional area divided by the distance from the C7 spinous process to T12 spinous process was 67 ± 7 % (99% CI 65 to 69)

Conclusions: When positioned prone, the largest LV cross-sectional area is 0-2 vertebral segments below the inferior angle of the scapula in at least 86% of patients. Further studies are needed to determine whether this position is optimal for chest compressions in the prone position.

Fig. 1. Distribution of the levels of anatomic landmarks and largest LV cross sectional area



Fig. 2. Optimal hand position level for cardiac comopression during prone CPR and distribution of the level of the largest LV cross sectional area in relation to the anatomic landmark
Figure 1
Figure 2

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