Transthoracic echocardiography is superior to AHA guidelines location in identifying the left ventricle for chest compressions.
Resuscitation plus · 2026-02-02 · Method & validation
Abstract
BACKGROUND: Standard CPR guidelines recommend chest compressions over the lower half of the sternum; however, this often results in compressions over the left ventricular outflow tract (LVOT) or proximal aorta, impeding blood flow. Improved outcomes have been noted when compressions are directed over the left ventricle. OBJECTIVE: We evaluated whether transthoracic echocardiography (TTE) can accurately identify the mid-left ventricle (mid-LV) and whether this approach aligns more closely with the true mid-LV than the standard American Heart Association (AHA) compression location based on computed tomography (CT) of the chest. METHODS: In this prospective observational study of adults undergoing chest CT, providers marked the AHA-recommended compression site and performed limited TTE to localize and mark the mid-LV. Radiopaque markers were placed at these locations and compared to CT-identified true mid-LV positions. RESULTS: Among 65 patients, the mean distance from the AHA location to the true mid-LV based on chest CT was 74.2 mm. The distance from the ultrasound guided mid-LV marker to the true mid-LV was 64.6 mm. Ultrasound trained providers outperformed non-ultrasound trained providers in accuracy of localization. We found the AHA position to be cranial and medial to the true mid-LV. On CT, the most common structure beneath the AHA marker was the proximal ascending aorta (38.5%). CONCLUSION: TTE-guided localization of the mid-LV is feasible and more accurate than the standard AHA landmark, particularly when performed by trained providers. A TTE-guided approach to mid-LV localization may optimize location of chest compression over the mid-LV, warranting further evaluation in resuscitation settings.