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:

1. 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.

2. 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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