What Is the Correct Depth of Chest Compression for Infants and Children? A Radiological Study

OBJECTIVE: For infant and child resuscitation, current basic life support guidelines recommend a compression depth of one third to one half of the anteroposterior chest diameter. This study was conducted to assess the actual compression depths in infants and children when current guidelines are strictly followed. PATIENTS AND METHODS: Chest computed tomography scans of 36 infants (< 1 year old) and 38 children (1-8 years old) were reviewed. Patient demographic data were collected from medical records. Measurements of the anteroposterior diameter from chest computed tomography scans were taken from the anterior skin at either the inter-nipple line or the middle of the lower half of the sternum, perpendicular to the skin on the posterior thorax. RESULTS: In the infant group (25 boys, 11 girls), the mean age was 3.6 months. In the child-age group (21 boys, 17 girls), the mean age was 4.0 years. Compression depths were 3.4 to 5.1 cm in the infant group and 4.4 to 6.6 cm in the child group when current guidelines were followed. There was no difference in compression depths measured at inter-nipple line versus in the lower half of the sternum. The intrathoracic structures observed beneath these 2 suggested that compression landmarks were similar. CONCLUSIONS: Radiological assessment of infants' and children's chests indicates similar or higher compression depths for infants and children versus the recommended compression depths for adults (3.8-5.1 cm) according to current guidelines. More evidence is needed to guide the proper depth of chest compression in pediatric populations. Pediatrics 2009;124:49-55