Pectus excavatum occurs in 1 in 400 white male births, it is a congenital chest wall deformity. Several ribs and the sternum tend to grow abnormally, producing a concave, or caved-in, appearance in the chest.

It is worth observing this before CPR.

If the chest is severely concaved (sunken hollow) BEFORE chest compressions, it is possible that the patient has ‘pectus excavatum’.

Current guidelines do not give any advice about chest compression technique in patients with chest wall deformities such as pectus excavatum.

Paramedics conducting CPR have recorded that they were unable to deliver effective compressions and that the sternal bar may have contributed to this. The case was a 21-year-old male with pectus excavatum who underwent a minimally invasive pectus repair but had a fatal cardiac event before bar removal.

Identifying a Nuss bar could be an issue prior to CPR and perhaps a slight scar to the side may be visible.

There are reports of patients being issued with wallets or medic alert bracelets with such words as – “Surgical steel bar in place under sternum” and on the back “CPR may require more exertional external force” – and admissions that patients have discarded them.

No Nuss bar is obvious by the extreme cavity and lower depth compressions are advised. In other words, don’t compress down as much as you would do normally.

In the event of a Nuss bar being evident, more force is required during CPR.

This text was taken from ‘First on Scene’ course by Peter Yexley.