Abstract:

Background and Objectives: High-quality chest compression during cardiopulmonary resuscitation (CPR) is a key step in saving cardiac arrest patients. Recent evidences suggest that a uniform chest compression depth may not be suitable for all adults with various body sizes. This study is to analyse the association of thoracic cage size and configuration with adult outcomes following in-hospital cardiac arrest (IHCA).

Methods: This was a single-center, retrospective cohort study. Adult patients experiencing IHCA during 2006–2015 were screened. By analysing computed tomography images, we measured thoracic anterior-posterior and transverse diameters, circumference, and both anterior and posterior subcutaneous adipose tissue (SAT) depths at the level of the internipple line (INL). We also identified and recorded the anatomical structure located immediately posterior to the sternum at the INL. The primary outcome was the association of thoracic cage size and configuration with patient outcomes.

Results: A total of 649 patients were included. The mean thoracic anterior-posterior diameter was 21.4 cm, mean thoracic circumference was 89.1 cm and mean thoracic transverse diameter was 31.7 cm. The mean anterior and posterior thoracic SAT depths were 1.0 and 1.7 cm, respectively. The ascending aorta was found to be the most common retrosternal structure (57.6 %) at the INL. Multivariate logistic regression analyses indicated that anterior thoracic SAT depth of 0.8–1.6 cm (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.40–6.35; p-value = 0.005) and thoracic circumference of 83.9–95.0 cm (OR: 2.48, 95% CI: 1.16–5.29; p-value = 0.02) were positively associated with a favourable neurological outcome while left ventricular outflow track or aortic root beneath sternum at the level of INL was inversely associated with a favourable neurological outcome (OR: 0.37, 95% CI: 0.15–0.91; p-value = 0.03).

Conclusion: Thoracic circumference and anatomic configuration were associated with IHCA outcomes. A one-size-fits-all CPR technique may not be suitable for all patients.