Ideal Compression Point in Fontan Circulation Patients with Dextrocardia Undergoing Cardiopulmonary Resuscitation: An Analysis Based on Contrast-enhanced Chest Computed Tomography

Abstract

We aimed to find the ideal chest compression point undergoing cardiopulmonary resuscitation (CPR) in patients with a single ventricle with dextrocardia corrected by Fontan surgery. The most recent saved chest computed tomography images of all patients 8 years or older with a single ventricle who underwent Fontan surgery were retrospectively analysed. We defined the ideal chest compression point as the largest part of the compressed single ventricle. To find the ideal chest compression point, we measured the distance from the midline of the sternum to the point of the maximum sagittal area of the single ventricle as a deviation and calculated the area fraction of the compressed structures. Fifty-eight patients (male 67.2%) were analysed. The mean right deviation from the midline of the sternum as the ideal compression point was almost like the mean sternum width (32.85 ± 15.61 vs. 31.05 ± 6.75 mm). When chest compression was performed at the ideal point, the area fraction of the single ventricle statistically significant increased by 7%, wider than conventional compression (0.15 ± 0.10 vs. 0.22 ± 0.11, p < 0.05). When performing CPR on a patient with Fontan circulation with dextrocardia, right-sided chest compression is better than the conventional location.