During chest compressions (CCs), the hand position at the lower half of the sternum is not strictly maintained, unlike depth or rate. This study was conducted to determine whether medical staff could adequately push at a marked location on the lower half of the sternum, identify where the inappropriate hand position was shifted to, and correct the inappropriate hand position.Methods: This simulation-based, prospective single-center study enrolled 44 medical personnel. Pressure and hand position during CC were ascertained using a flexible pressure sensor. The participants were divided into four groups by standing position and the hand in contact with the sternum: right-left (R-l), right-right (R-r), left-right (L-r), and left-left (L-l). We compared the groups and the methods: the manual method (MM), the thenar method, and the hypothenar method (HM).Results: Among participants using the MM, 80% did not push adequately at the marked location on the lower half of the sternum; 60%-90% of the inadequate positions were shifted to the hypothenar side. CCs with the HM facilitated stronger pressure, and the position was minimally shifted to the hypothenar side.Conclusion: Medical staff could not push at an appropriate position during CCs. Resuscitation courses should be designed to educate personnel on the appropriate position for application of maximal pressure while also evaluating the position during CCs.

Background The 2020 American Heart Association guidelines recommend the use of a feedback device during chest compressions (CCs). However, these devices are only placed visually by medical personnel on the lower half of the sternum and do not provide feedback on the adequacy of the pressure-delivery position. In this study, we investigated whether medical staff could deliver CCs at the adequate compression position using a feedback device and identified where the inadequate position was compressed. Methods This simulation-based, prospective single-centre study enrolled 44 medical personnel who were assigned to four different groups based on the standing position and the hand in contact with the feedback device as follows: right–left (R–l), right–right (R–r), left–right (L–r), and left–left (L–l), respectively. The sensor position where the maximal average pressure was applied during CCs using the feedback device were ascertained with a flexible capacitive pressure sensor. We determined if this position is the adequate compression position or not. The intergroup differences in the frequency of the adequate compression position, the maximal average pressure, compression rate, depth and recoil were determined. Results The frequencies of adequate compression positioning were 55, 50, 58, and 60% in the R–l, R–r, L–r, and L–l groups, respectively, with no significant intergroup difference (p = 0.917). Inadequate position occurred in the front, back, hypothenar and thenar sides. The maximal average pressure did not significantly differ among the groups (p = 0.0781). The average compression rate was 100–110 compressions/min in each group, the average depth was 5–6 cm, and the average recoil was 0.1 cm, with no significant intergroup differences (p = 0.0882, 0.9653, and 0.2757, respectively). Conclusions We found that only approximately half of the medical staff could deliver CCs using the feedback device at an adequate compression position and the inadequate position occurred in all sides. Resuscitation courses should be designed to educate trainees about the proper placement during CCs using a feedback device while also evaluating the correct compression position.

No abstract

We report the case of a 77-year-old man who was under treatment for lacunar infarction of the left posterior limb of the internal capsule. On the 11th day from the onset of the cerebral infarction, he suffered from chest pain and dyspnea with cyanosis immediately after nasogastric tube insertion. A chest roentgenogram showed pulmonary congestion, and an electrocardiogram showed prolonged QT interval, which was not recognized in the patient＇s electrocardiogram on admission. Although the latter electrocardiogram did not show the change of ST-segment, echocardiography showed diffuse asynergy of the apex of the left ventricle, with an ejection fraction (EF) of 36%. C oronary angiography was not performed due to the patient＇s poor general condition and unrest. His heart failure gradually improved with conservative treatment, and the EF had increased to 61% on the 28th day from the onset of chest pain and dyspnea. These findings were diagnostic of takotsubo cardiomyopathy. The potential triggers of takotsubo cardiomyopathy are physical and psychic stress, pneumonia, hyponatremia, asthma, cerebral infarction, and others. There are no reports that nasogastric tube insertion is a trigger of Takotsubo cardiomyopathy. We suspect that this patient＇s nasogastric tube insertion was a trigger because he developed Takotsubo cardiomyopathy immediately after the nasogastric tube insertion. Clinicians should be aware that although the insertion of a nasogastric tube is a common treatment, it can be a trigger for Takotsubo cardiomyopathy.