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Optimal Chest Compression Position for Patients With a Single Ventricle During Cardiopulmonary Resuscitation*

Objectives: Few studies have examined cardiopulmonary resuscitation for patients with congenital heart disease, although they are at a high risk of cardiac arrest. Therefore, this study investigated the optimal chest compression position in patients with a single ventricle while providing them with basic life support. Design: This is a retrospective study of patients with a single ventricle who are undergoing chest CT. Setting: Tertiary teaching children’s hospital. Patients: A total of 185 patients with a single ventricle, including 73 patients before a bidirectional cavopulmonary shunt, 61 patients after a bidirectional cavopulmonary shunt, and 51 patients after the Fontan operation. Interventions Chest CT scans were reviewed. Measurements and Main Results: Sternal length was defined as the distance from the suprasternal notch to the xiphisternal junction. The optimal level of external cardiac compression was defined as the level at which the cross-sectional area of the systemic ventricle was the largest. The distance from the suprasternal notch to this level over the sternum was calculated. The structures below the intermammary line, the lower half and the lower third of the sternum, and the optimal level were determined. The level with the largest cross-sectional area of the ventricle was approximately the lower fourth of the sternum in all surgical stages: 86.5% ± 4.9% of the sternal length from the suprasternal notch before bidirectional cavopulmonary shunt, 85.9% ± 4.8% after bidirectional cavopulmonary shunt, and 86.4% ± 6.3% after the Fontan operation. The liver was not identified at any level, whereas the ascending aorta was detected in 2.2%, 3.8%, and 24.9% at the level of the lower third of the sternum, the intermammary line, and the lower half of the sternum, respectively. Conclusions: The optimal compression position in patients with a single ventricle is approximately 5–25% of the lower sternum. The optimal compression level for patients with a single ventricle is lower than that suggested in current guidelines for the normal population.