Cardiopulmonary resuscitation is a life saving process . over years it has undergone changes most prominently in the field of chest compression because high quality chest compression deeply affects outcomes . Chest compression point plays a important role in this regard . Guidelines has changed little in this fundamental part of high quality CPR although ever increasing data denotes its utmost importance .

1. Optimal chest compression point
Does one size fit all
Mansoor Masjedi MD
Associate professor , Critical care consultant
Instructor of AHA , ICU BASIC course & Instructor potential of ATLS
Founder and director of Fars Cardiopulmonary resuscitation Training Center ( FCTC )
Shiraz University of Medical Sciences , Shiraz , Iran

2. Optimal chest compression point - Does one size fit all- M.Masjedi MD
I have no conflict of interest

3. 45 y/o male , OHCA , PEA , standard ACLS

4. Optimal chest compression point - Does one size fit all- M.Masjedi MD

5. How chest compressions generate blood flow ?
Thoracic &/or Cardiac pump
C.O. with ideal chest compressions ;
at best 25% to 30%

6. The resuscitation guidelines have changed little from their introduction in the 1960’s

8. Optimal chest compression point
Does one size fit all ?!

10. Chest CT scan : spatial relationship between
surface landmarks on chest & inner viscera underneath them

11. Discussion:
LVOT/AV/aortic root was present beneath the origo in almost 50% of pts with cardiac dis.
OCP was found 3 cm left to the origo.
Conclusions:
Based on our study, individualized compression point and depth could be further studied
The most frequent dominating structure in all pts was left
atrium (41 %) or right ventricle (31 %)
The left ventricle was not the dominating structure in any pt.

12. Conclusion:
OPLV on sternum in obese individuals was more cranial than nl wt individuals
Optimal point for chest compression in obese individuals could be slightly more cranial

13. Conclusion:
 One size does not fit all
 The point recommended by current guideline may not appropriate for Chinese person.
 Further studies are required focusing on individual chest compression during CPR

14. Anatomical correlation of sternal chest compression point and underlying heart structures based
on chest computed tomography
 Retrospective data analysis of 30 non-trauma pts without underlying
cardiovascular & pulmonary disease
A : Internipple line
B : Mid point between A & B
C : Xiphisternal junction
Mansoor Masjedi , Taha Takavar , Mohammad reza Sasani
Conclusion :
Wide variety of sternal length between individuals
Correlation of chest compression point with underlying heart structures changes with age

15. Conclusions:
 The location of LVmax in the arms-down position to be lower than the guideline-recommended landmark.
 To optimize chest compression, we suggest placing the left hand down & the lowest hand’s border (ulnar border) located at
lower end of sternum while staying on lt side of pt.
 For the new landmark, outcomes and complications should be evaluated in further investigation
J. Cardiovasc. Dev. Dis. 2022, 9, 100. https://doi.org/10.3390/jcdd9040100

18. Conclusions: The outflow of the left ventricle is affected during standard CPR,
resulting in varying degrees of narrowing in the LVOT and ⁄ or the aortic root
To investigate whether the recommended hand position for external chest compression
is optimal for compressing ventricles during standard CPR by observing heart with TEE

19. Conclusion
Monitoring & optimizing chest compressions using capnography was feasible.
We could not demonstrate one superior hand position,
but inter-individual differences suggest optimal hand position might vary significantly among pts.

20. 2013
Conclusions:
Compared to standard compression, alternative compression results in
a higher peak art. pressure & ETCO2 , but no change in CPP
Alternative compression
lower end of the sternum
standard external
chest compression
They enrolled 17 non-traumatic cardiac arrest pts ,
compared hemodynamics & ETCO2 during last 2 min of
standard vs alternative compression

21. Conclusions: In our swine model of cardiac arrest,
chest compressions over LV improved hemodynamics &
Resulted in a greater ROSC & survival to 60 minute
LV
Standard

22. American Heart Association Scientific Sessions 2017
Role of POCUS in CA
IHCA/OHCA

24. Conclusions: EtCO2 positively correlated with all parameters under consideration,
while strongest correlation was found between maximal compression index & EtCO2
Therefore, CImax is a candidate parameter for guidance of hemodynamic-directed CPR
Correlation between end-tidal carbon
dioxide and the degree of compression of
heart cavities measured by transthoracic
echocardiography during cardiopulmonary
resuscitation for out-of-hospital cardiac
arrest
ETCo2
TTE
Heart
cavities
compression index of LV (LVCI) & RV (RVCI)
Maximal compression index (CImax)

25. Conclusion: Point_optimum might be located far rightwards to Point_max.RV, challenging the
traditional assumption identifying Point_optimum as Point_max.LV

27. Wrap it up

28. Optimal chest compression point ; Does one size fit all – M.Masjedi MD
1) Is the quality of CPR affected by the position of hands/CPR device ? Yes
2) Are there any studies on this issue ? Yes
3) Can we enhance the quality of CPR ? Yes
4) Does one size fit all ? No

29. There is insufficient evidence for or against a specific hand position for chest compression in adults
A potentially more efficient CPR might consider CC started on lower half of sternum,
but then continued on optimal thorax point

30. Optimal chest compression point ; Does one size fit all – Dr M.Masjedi
We need more human studies
Resuscitation & ultrasound ; need to come together
Wearable devices & sensors that can monitor any intervention in real time
Personalized medicine
Artificial intelligence

31. Optimal chest compression point ; Does one size fit all
We all together will improve saving lives

32. Hope to see you in shiraz - Iran
Thanks for your patience & attention 32
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