Basic life support providers’ assessment of centre of the chest and inter-nipple line for hand position and their underlying anatomical structures

Abstract

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.

Different perceptions of thorax anatomy and hand placement for chest compressions among healthcare professionals and laypersons: Implications for cardiopulmonary resuscitation

“…Notably, the guideline recommendation of placing the hands on the centre of the chest was primarily based on studies of healthcare professionals or healthcare students, similar to a number of other guideline recommendations. 4 , 5 , 7 , 8 , 9 , 23 , 24 Our findings support that the current guideline recommendation for placing the heel of the hand in the centre of the chest can be used for both laypersons and healthcare professionals. However, the findings of different perceptions of chest anatomy and different perceptions of correct hand placement suggest that caution should be taken when extrapolating findings from healthcare professionals to laypersons in the evaluation of CPR science.…”

“… 8 However, several studies suggest that a hand-position too cranial would compress the ascending aorta or the left ventricular outflow tract, which could lead to lower systolic blood pressures and less effective chest compressions. 9 , 10 , 11 , 12 …”

“…However, the pictures used in this study are more representative for a real cardiac arrest patient when compared to the resuscitation manikins used in previous studies. 5 , 7 , 8 , 9 In addition, there was a weight variation (79 kg and 105 kg) in the patients in the digital pictures, which may have impacted on clearly delineating the borders of e.g. the patient's sternum and diaphragm.…”

“…The majority of studies providing evidence for resuscitation guidelines include healthcare professionals such as emergency medical technicians, medical students, nurses, and physicians. 5 , 7 , 8 , 9 The results of these studies are extrapolated to laypersons, irrespective of differences in experience, knowledge, and training. However, whether findings from healthcare professionals can be extrapolated to the lay public remains to be investigated.…”

New pre-arrival instructions can avoid abdominal hand placement for chest compressions

“…Test subjects had to use their perception of these landmarks to guide themselves. Yeong reported less variability using internipple line as landmark compared to center of the chest, when identifying the location on a photo of dressed patients [22]. In addition, we observed participants in our previous simulation study who understood the center of the chest to be the same as the center of the torso.…”