Emergency Medical Minute17 Aug

Podcast 1017: CPR Hand Placement

Contributor: Taylor Lynch, MD

Educational Pearls:

CPR is an important life-saving measure designed for anyone to perform.

Chest compressions works by two mechanisms:

Cardiac pump: Direct squeezing of the heart
Thoracic pump: Increasing intrathoracic pressure, causing increased blood flow

Proper hand placement per current AHA guidelines:

Hands are placed in the center of the chest, on the lower half of the sternum

A recent study challenged this approach, using TEE during chest compressions to visualize the cardiac structures being compressed.

They found that when hands were placed ~1cm to the left of the sternum, this compressed the left ventricular outflow tract, potentially restricting forward blood flow.
Hand placement ~4cm to the left of the sternum resulted in more effective compression of the left ventricle.

While this is not yet reflected in AHA guidelines, the study presents an interesting finding that may influence how CPR is performed in the future.
Key takeaway: Always prioritize administering high quality compressions.

References:

American Heart Association. 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(23_suppl_1). doi:10.1161/CIR.0000000000001378.
Chu S, Cheng C, Chang C, et al. Transesophageal echocardiography during CPR in patients with out-of-hospital cardiac arrest: the EXECT-CPR randomized clinical trial. JAMA Intern Med. 2026;186(5):557-566. doi:10.1001/jamainternmed.2026.0102.

Summarized by Ashley Lyons, OMS4 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P

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