Adjusting the Hand Placement of Chest Compressions 4 cm Lateral to the Sternum

Emerging evidence suggests that the universally accepted hand placement during chest compressions may miss the ideal area of maximal compression (iAMC), impairing perfusion. By reporting the locations of the iAMC and left ventricular outflow tract (LVOT), we hope to align hand placement over the iAMC to improve compression quality.

We enrolled 152 adults presenting to an emergency department between July 2024 and December 2025. First, the xiphoid process, sternal notch, and the distance between them were identified. Next, a standardized 1 x 1 cm grid was placed over the xiphoid process. A transthoracic echocardiography (TTE) exam identified the iAMC and LVOT locations as grid coordinates. Heat maps illustrated the distribution patterns of the iAMC and LVOT. Continuous variables are reported as medians with interquartile ranges. The correlation between the horizontal positions of the iAMC and LVOT was assessed using Pearson’s correlation coefficient with a 95% confidence interval.

The median distance between the sternal notch and the xiphoid process was 21cm (18-22). The median horizontal distance from the sternum for the iAMC was 4cm (3–5) and 1.5cm (1–2) for the LVOT. The LVOT was located within 1 cm of the sternum in 49.3% of participants, compared to only 2.7% for the iAMC. A moderate positive correlation was observed between the iAMC and LVOT distances (r = 0.49; 95% CI, 0.36–0.60; p<0.001).

The iAMC was located approximately 4cm lateral to the sternum, whereas the LVOT was positioned only 1.5 cm away. By adjusting the position of cardiopulmonary resuscitation hand placement from the midline more laterally over to the iAMC, perfusion may be improved.