Clin Exp Emerg Med.  2019 Dec;6(4):303-313. 10.15441/ceem.19.016.

Determination of the theoretical personalized optimum chest compression point using anteroposterior chest radiography

  • 1Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
  • 2Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.


There is a traditional assumption that to maximize stroke volume, the point beneath which the left ventricle (LV) is at its maximum diameter (P_max.LV) should be compressed. Thus, we aimed to derive and validate rules to estimate P_max.LV using anteroposterior chest radiography (chest_AP), which is performed for critically ill patients urgently needing determination of their personalized P_max.LV.
A retrospective, cross-sectional study was performed with non-cardiac arrest adults who underwent chest_AP within 1 hour of computed tomography (derivation:validation=3:2). On chest_AP, we defined cardiac diameter (CD), distance from right cardiac border to midline (RB), and cardiac height (CH) from the carina to the uppermost point of left hemi-diaphragm. Setting point zero (0, 0) at the midpoint of the xiphisternal joint and designating leftward and upward directions as positive on x- and y-axes, we located P_max.LV (x_max.LV, y_max.LV). The coefficients of the following mathematically inferred rules were sought: x_max.LV=α₀*CD-RB; y_max.LV=β₀*CH+γ₀ (α₀: mean of [x_max.LV+RB]/CD; β₀, γ₀: representative coefficient and constant of linear regression model, respectively).
Among 360 cases (52.0±18.3 years, 102 females), we derived: x_max.LV=0.643*CD-RB and y_max.LV=55-0.390*CH. This estimated P_max.LV (19±11 mm) was as close as the averaged P_max.LV (19±11 mm, P=0.13) and closer than the three equidistant points representing the current guidelines (67±13, 56±10, and 77±17 mm; all P<0.001) to the reference identified on computed tomography. Thus, our findings were validated.
Personalized P_max.LV can be estimated using chest_AP. Further studies with actual cardiac arrest victims are needed to verify the safety and effectiveness of the rule.


Cardiopulmonary resuscitation; Heart arrest; Intensive care units; Radiography, thoracic; Tomography, X-ray computed

MeSH Terms

Cardiopulmonary Resuscitation
Critical Illness
Cross-Sectional Studies
Heart Arrest
Heart Ventricles
Intensive Care Units
Linear Models
Radiography, Thoracic
Retrospective Studies
Stroke Volume
Tomography, X-Ray Computed
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