Optimal Landmark for Chest Compressions during Cardiopulmonary Resuscitation Derived from a Chest Computed Tomography in Arms-Down Position

Compressions at the left ventricle increase rate of return of spontaneous circulation. This study aimed to identify the landmark of the point of maximal left ventricular diameter on the sternum (LVmax) by using chest computed tomography (CCT) in the arms-down position, which was similar to an actual cardiac arrest patient. A retrospective study was conducted between September 2014 and November 2020. We included adult patients who underwent CCT in an arms-down position and measured the rescuer’s hand. We measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand, which placed the lowest palmar margin of the rescuer’s reference hand at the xiphisternal junction. Thirty-nine patients were included. The LVmax was located below the lower half of the sternum; DLVmax and DLH were 12.6 and 10.0 cm, respectively (p < 0.001). Distance from the sternal notch to the point of maximal force of the left hand, with the ulnar border located at the xiphisternal junction, was close to DLVmax; 11.3 and 12.6 cm, respectively (p = 0.076). In conclusion, LVmax was located below the lower half of the sternum, which is recommended by current guidelines

Efficiency of Mobile Application of Thai Criteria Based Dispatch: A Randomized Controlled Crossover Trial

The main purpose of the emergency medical system is a timely and appropriate response that significantly impacts health outcomes. In Thailand, due to lack of staff, emergency medical personnel at the dispatch center have to multitask to interview and dispatch the EMS responses. According to these problems the novel triage mobile application “Triagist” was developed based on Criteria Based Dispatch (CBD) to optimize prehospital care.  This study is a pilot study aiming to test the app by evaluating the reliability and rapidity of code dispatching using “Triagist” compared with the usual method; ITEMS, Criteria Based Dispatch Handbook, or emergency medical personnel’ experiences only.A randomized-controlled crossover (AB/BA) design was conducted which compared mobile application “Triagist” and conventional methods. Eighteen experienced emergency medical personnel each were randomly assigned to AB or BA arm.  The primary outcome measure was the accuracy and rapidity of code dispatching to 6 simulated scenarios among experienced emergency medical personnel. Using triage mobile application by experienced emergency medical personnel had gained a chance of correct dispatch 1.5 times, which was significantly more accurate than the conventional method (95%CI 1.03-2.28) and also significantly more rapid dispatch than the conventional method (82 vs 95 sec., p = 0.03

Optimal Landmark for Chest Compressions during Cardiopulmonary Resuscitation Derived from a Chest Computed Tomography in Arms-Down Position

Compressions at the left ventricle increase rate of return of spontaneous circulation. This study aimed to identify the landmark of the point of maximal left ventricular diameter on the sternum (LVmax) by using chest computed tomography (CCT) in the arms-down position, which was similar to an actual cardiac arrest patient. A retrospective study was conducted between September 2014 and November 2020. We included adult patients who underwent CCT in an arms-down position and measured the rescuer’s hand. We measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand, which placed the lowest palmar margin of the rescuer’s reference hand at the xiphisternal junction. Thirty-nine patients were included. The LVmax was located below the lower half of the sternum; DLVmax and DLH were 12.6 and 10.0 cm, respectively (p p = 0.076). In conclusion, LVmax was located below the lower half of the sternum, which is recommended by current guidelines