Yeung, Joyce, Butler, Thomas, Digby, James W., Hughes, John, Higgie, David, Minshall, Mark, Miller, Ben, Smith, F. Gao (Fang Gao) and Perkins, Gavin D.. (2011) Basic life support providers’ assessment of centre of the chest and inter-nipple line for hand position and their underlying anatomical structures. Resuscitation, Vol.82 (No.2). pp. 190-194. ISSN 0300-9572

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Abstract

INTRODUCTION Effective chest compression is an integral part of good quality cardiopulmonary resuscitation. There remains uncertainty over the optimal method for identifying the correct hand position for chest compression. The aim of this study was to identify the relationship between basic life support (BLS) providers assessment of the inter-nipple line (INL) versus the centre of the chest (CoC) and to identify the anatomical structures underneath these land marks. METHOD Thirty consecutive patients having elective CT scans of the thorax were recruited and photographs of the patient fully clothed were taken in the supine position. 30 healthcare students trained in BLS were asked to mark the ‘point between the nipples’ and the ‘centre of the chest’ on each photograph in a random sequence. Corresponding points were marked on the CT images and the underlying anatomical structures were identified. RESULTS Hand positions using CoC landmark were significantly higher and were more variable than INL landmark (Measurement represented as ratio of sternal length: mean CoC 0.709, 95% CI 0.677, 0.740 vs mean INL 0.803 95% CI 0.772, 0.835; p<0.0001). Structures underneath CoC and INL hand positions were significantly different; CoC compressing predominantly the aortic arch and ascending aorta and INL compressing the left ventricle and left ventricular outflow (p<0.001). Hand positions were not significantly affected by gender of patients. CONCLUSION Both the centre of the chest landmark and inter-nipple line identify positions on the lower third of the sternum. The centre of the chest technique identifies a point that is consistently higher and more variable than the inter-nipple line. Structures compressed under both landmarks were different although the implications of this are unknown.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Cardiac resuscitation -- Methodology, Chest -- Anatomy
Journal or Publication Title:	Resuscitation
Publisher:	Elsevier Ireland Ltd
ISSN:	0300-9572
Date:	February 2011
Volume:	Vol.82
Number:	No.2
Page Range:	pp. 190-194
Identification Number:	10.1016/j.resuscitation.2010.10.008
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
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URI:	http://wrap.warwick.ac.uk/id/eprint/4488

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