Using computed tomography to evaluate proper chest compression depth for cardiopulmonary resuscitation in Thai population: A retrospective cross-sectional study

Pongsakorn Atiksawedparit; Thanaporn Sathapornthanasin; Phanorn Chalermdamrichai; Pitsucha Sanguanwit; Nitima Saksobhavivat; Ratchanee Saelee; Phatthranit Phattharapornjaroen

doi:10.1371/journal.pone.0279056

Peer Review History

Original SubmissionMarch 7, 2022
15 Jul 2022 Decision Letter - Simone Savastano, Editor PONE-D-22-06863Using Computed Tomography to Evaluate Proper Chest Compression Depth for Cardiopulmonary Resuscitation in Thai Population: A Retrospective Cross-Sectional StudyPLOS ONE Dear Dr. Phattharapornjaroen, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR: Thank you very much for having submitted your paper for consideration. Some issues have been raised by the reviewers. Please follow their indication to try and improve your manuscript ============================== Please submit your revised manuscript by Aug 29 2022 11:59PM. 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Some issues have been raised by the reviewers. Please follow their indication to try and improve your manuscript [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The depth of chest compressions depends on the rescuer's BMI anywhere in the world. My brother-in-law (Thai nurse) weighs 78 kg and 174 centimeters tall, he certainly has no problem make chest compression 5 -6 centimeters deep a European patient. Much depends on the difference in weight between the rescuer and the victim also in the Caucasians and Asians populations. Reviewer #2: This is an interesting retrospective study regarding the distribution of heart compression fraction among different sex and BMI in Thai population. The conclusion is that the recommended depth of chest compression during cardiac arrest (5-6 cm) is validated (with the simulated chest ct scan model in object) also in Thai population. The article is well written in sound English, easy to read, and the conclusions stem clearly from data and discussion. References are coherent with the text. Some minor issues come to mind: - "Currently, computed tomography (CT) scan with contrast of chest was used to simulate heart compression fraction (HCF), which is the proportion of the heart compressed by CC [15], and HCF was subsequently mentioned in several studies to demonstrate high-quality CC during CPR in various populations [16,17]" this section could be expanded a little to explain clearly the link between heart compression fraction and high quality CPR. - However this has been correctly addressed by the authors, it is to be noted that the population enrolled in the study may not be representative of the general population nor of the population most affected by cardiac arrest in Thailand (most notably only 3.3% of patients were admitted for cardiac illness). If there were any patients affected by cardiac arrest in the population in study, it may be reasonable to underline this data (otherwiseif patients resuscitated form cardiac arrest were excluded, absent or very few, then it should be disclosed as it is a significant limitation). - The notion that "although lower HCF was found in the obese groups, sufficient HCF was generated at 60 mm CC depth" may be included in the conclusions, since it may yeald a relevant message for the local physicians to keep in mind when managing patients with higher BMI during cardiac arrest. Other than these minor issues, the article seems fit for publication. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0279056.r001
Revision 1
19 Aug 2022 Author Response Dear Editor, Thank you very much for giving us the opportunity to revise our manuscript. We have responded to all questions and comments as described below; if any further unclear, please do let us know. Sincerely, Phatthranit Phattharapornjaroen Corresponding author Response to reviewers #1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes Answer: To add more information to our study, we have included sample size estimation and further statistical analysis parts as described on pages 6,7 Line 117-130. In addition, we have also added more conclusions and suggestions which relevant to the objective and our result on pages 8, lines 156-157, and on pages 10, lines 199-201. #2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes Answer: For more rigorous statistical analysis, we performed further analysis by controlling for possible confounders (i.e., age and sex), which might affect the primary outcomes. Revised statistical part and results were on page 8, lines 156-157, and Table 4., subsequently. #3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exceptions (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes Answer: We have provided the raw data in the supplementary file attached to this revised submission. 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Answer: Thank you for the reviewers’ comments. #5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The depth of chest compressions depends on the rescuer's BMI anywhere in the world. My brother-in-law (Thai nurse) weighs 78 kg and 174 centimeters tall, he certainly has no problem make chest compression 5 -6 centimeters deep a European patient. Much depends on the difference in weight between the rescuer and the victim also in the Caucasians and Asians populations. Answer: We agreed with your comments that the factor associated with chest compression depth was the rescuers’ BMI. And there were several studies mentioned on this topic [1]. However, our research question focused on whether the recommendation depth from the USA and Europe regions were appropriate for Asian patients, who may have different sizes of anatomical parameters. In addition, we examined whether too deep or too shallow compression affects the quality of compression or internal organ injury. References Lin C-C, Kuo C-W, Ng C-J, Li W-C, Weng Y-M, Chen J-C. Rescuer factors predict high-quality CPR—a manikin-based study of health care providers. Am J Emerg Med. 2016;34: 20–24. doi:10.1016/j.ajem.2015.09.001 #Reviewer #2: This is an interesting retrospective study regarding the distribution of heart compression fraction among different sex and BMI in Thai population. The conclusion is that the recommended depth of chest compression during cardiac arrest (5-6 cm) is validated (with the simulated chest ct scan model in object) also in Thai population. The article is well written in sound English, easy to read, and the conclusions stem clearly from data and discussion. References are coherent with the text. Answer: Thank you for the reviewer’s comments and suggestions to improve the article. #Some minor issues come to mind: - "Currently, computed tomography (CT) scan with contrast of chest was used to simulate heart compression fraction (HCF), which is the proportion of the heart compressed by CC [15], and HCF was subsequently mentioned in several studies to demonstrate high-quality CC during CPR in various populations [16,17]" this section could be expanded a little to explain clearly the link between heart compression fraction and high quality CPR. Answers According to the reviewer’s suggestion, we have added more information on page 4, lines 64-69 #- However this has been correctly addressed by the authors, it is to be noted that the population enrolled in the study may not be representative of the general population nor of the population most affected by cardiac arrest in Thailand (most notably only 3.3% of patients were admitted for cardiac illness). If there were any patients affected by cardiac arrest in the population in study, it may be reasonable to underline this data (otherwiseif patients resuscitated form cardiac arrest were excluded, absent or very few, then it should be disclosed as it is a significant limitation). Answers We agree with the reviewer’s comment, and we have added this limitation on pages 9,10, lines 188-192. #- The notion that "although lower HCF was found in the obese groups, sufficient HCF was generated at 60 mm CC depth" may be included in the conclusions, since it may yeald a relevant message for the local physicians to keep in mind when managing patients with higher BMI during cardiac arrest. Answers We have added this information on page 10, lines 197-199. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0279056.r002
1 Dec 2022 Decision Letter - Simone Savastano, Editor Using Computed Tomography to Evaluate Proper Chest Compression Depth for Cardiopulmonary Resuscitation in Thai Population: A Retrospective Cross-Sectional Study PONE-D-22-06863R1 Dear Dr. Phattharapornjaroen, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Simone Savastano Academic Editor PLOS ONE Additional Editor Comments (optional): Thank you very much for your work and for having addressed the reviewers' comments. Even though some scepticism of one of the reviewer I think that the paper might be published. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: We have already received studies from Asian countries that hypothesize differences in quality in chest compressions given by rescuers with a smaller than slight of build. The effectiveness of compressions is given by constant training, correction of body posture, stiffness of the rescuer's arms, use of the pelvis as a fulcrum. Therefore, during courses aimed at the Asian population, instructors should work with simulators that give immediate feedback regarding the depth of compressions and work with the student to improve the technique. Reviewer #2: Thank you for addressing my precedent concerns; however i still have two comments: - the formula in line 114 is not visible any more, maybe because of some formatting error? - I respectfuly disagree with you conclusion in line 193-195: chronic lung and heart disease in fact do increase their volumes and alter thoracic anatomy. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0279056.r003
Formally Accepted
4 Dec 2022 Acceptance Letter - Simone Savastano, Editor PONE-D-22-06863R1 Using Computed Tomography to Evaluate Proper Chest Compression Depth for Cardiopulmonary Resuscitation in Thai Population: A Retrospective Cross-Sectional Study Dear Dr. Phattharapornjaroen: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Simone Savastano Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0279056.r004

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