Open Access Open Badges Case report

Association of arterial blood pressure and CPR quality in a child using three different compression techniques, a case report

Marko Sainio1*, Robert M Sutton2, Heini Huhtala3, Joar Eilevstjønn4, Jyrki Tenhunen5, Klaus T Olkkola6, Vinay M Nadkarni2 and Sanna Hoppu7

Author Affiliations

1 Department of Intensive Care Medicine, Critical Care Medicine Research Group, Tampere University Hospital and University of Tampere, PO Box 2000, Tampere, FI-33521, Finland

2 Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

3 Lecturer in Biostatistics, School of Health Sciences, University of Tampere, Tampere, FI-33014, Finland

4 Laerdal Medical AS, PO Box 377, Stavanger, N-4002, Norway

5 Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, SE 751 85, Sweden

6 Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, PO Box 52, Turku, FI-20521, Finland

7 Department of Emergency Medicine, Department of Intensive Care Medicine and Emergency Medical Services, Critical Care Medicine Research Group, Tampere University Hospital and University of Tampere, PO Box 2000, Tampere, FI-33521, Finland

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:51  doi:10.1186/1757-7241-21-51

Published: 2 July 2013


A 2-year-old boy found in cardiac arrest secondary to drowning received standard CPR for 35 minutes and was transported to a tertiary hospital for rewarming from hypothermia.

Chest compressions in hospital were started using two-thumb encircling hands technique. Subsequently two-thumbs direct sternal compression technique and after sternal force/depth sensor placement, chest compression with classic one-hand technique were done. By using CPR recording/feedback defibrillator, quantitative CPR quality data and invasive arterial pressures were available for analyses for 5 hours and 35 minutes.

316 compressions with the two-thumb encircling hands technique provided a mean (SD) systolic arterial pressure (SAP) of 24 (4) mmHg, mean arterial pressure (MAP) 18 (3) and diastolic arterial pressure (DAP) of 15 (3) mmHg. ~6000 compressions with the two thumbs direct compression technique created a mean SAP of 45 (7) mmHg, MAP 35 (4) mmHg and DAP of 30 (3) mmHg. ~20,000 compressions with the sternal accelerometer in place produced SAP 50 (10) mmHg, MAP 32 (5) mmHg and DAP 24 (4) mmHg.

Restoration of spontaneous circulation (ROSC) was achieved at the point when the child achieved normothermia by using peritoneal dialysis. Unfortunately, the child died ten hours after ROSC without any signs of neurological recovery.

This case demonstrates improved hemodynamic parameters with classic one-handed technique with real-time quantitative quality of CPR feedback compared to either the two-thumbs encircling hands or two-thumbs direct sternal compression techniques. We speculate that the improved arterial pressures were related to improved chest compression depth when a real-time CPR recording/feedback device was deployed.

Trial registration NCT00951704.

Cardiac Arrest; Child; Quality; CPR