“…19 , 24 , 26 , 27 , 28 , 30 , 32 , 33 , 35 , 36 The arrest precipitant was incompletely described, but, five patients had air emboli, 26 , 28 , 29 , 33 three had cardiac decompensation, 17 , 25 , 35 three had airway obstruction, 32 , 36 two had excessive parasympathetic stimulation 27 , 32 and one had cardiac tamponade. 31 The most common initial rhythm was pulseless electrical activity (n = 11, 44%), 17 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 32 followed by asystole (n = 4, 16%). 22 , 29 , 33 Refer to Table 2 for summary table of included cases.…”
Section: Resultsmentioning
confidence: 99%
“… Author, year Age Sex Diagnosis Type of surgery Rhythm Confirmation of CPR quality Cause of arrest Outcome (neurological ideally) Al Harbi, 2020 17 80 Male Spine surgery Posterior spinal fusion with laminectomy PEA, asystole ETCO 2 10 mmHg with prone CPR but no palpable pulse. When switched to supine, ETCO 2 increased & had palpable CPR pulses Intraoperative NSTEMI due to hypovolemia Survived Brock-Utne, 2011 18 28 Male Pelvic fractures Open reduction internal fixation PEA Systolic pressures over 80 mmHg (from arterial wave form) Pulmonary embolus Survived (discharged from hospital with intact neurologic status) Burki, 2017 19 6 Female Ventricle tumor excision Posterior cranial fossa PEA Not discussed Hemorrhagic shock ROSC, died 5 days post-surgery Chauhan, 2016 20 49 Male Prolapsed intervertebral disc Lumbar discectomy PEA, asystole Not discussed Unknown Survived Cho, 2010 21 18 Female Congenital posterior scoliosis Deformity correction and fusion with instrumentatio...…”
Section: Resultsmentioning
confidence: 99%
“…Twenty of the 25 cases (80%) were associated with post-resuscitation survival, although few cases included long term outcome. 17 , 18 , 20 , 21 , 22 , 23 , 24 , 26 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 36 The most commonly reported survival endpoint was alive at the end of surgery, 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 34 followed by survival to hospital discharge, 18 , 25 , 28 , 31 and seven cases reported full neurological recovery. 18 , 24 , 30 , 31 , 34 , 35 , 36…”
Aim
To identify and summarize the available science on prone resuscitation. To determine the value of undertaking a systematic review on this topic; and to identify knowledge gaps to aid future research, education and guidelines.
Methods
This review was guided by specific methodological framework and reporting items (PRISMA-ScR). We included studies, cases and grey literature regarding prone position and CPR/cardiac arrest. The databases searched were MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Scopus and Google Scholar. Expanded grey literature searching included internet search engine, targeted websites and social media.
Results
Of 453 identified studies, 24 (5%) studies met our inclusion criteria. There were four prone resuscitation-relevant studies examining: blood and tidal volumes generated by prone compressions; prone compression quality metrics on a manikin; and chest computed tomography scans for compression landmarking. Twenty case reports/series described the resuscitation of 25 prone patients. Prone compression quality was assessed by invasive blood pressure monitoring, exhaled carbon dioxide and pulse palpation. Recommended compression location was zero-to-two vertebral segments below the scapulae. Twenty of 25 cases (80%) survived prone resuscitation, although few cases reported long term outcome (neurological status at hospital discharge). Seven cases described full neurological recovery.
Conclusion
This scoping review did not identify sufficient evidence to justify a systematic review or modified resuscitation guidelines. It remains reasonable to initiate resuscitation in the prone position if turning the patient supine would lead to delays or risk to providers or patients. Prone resuscitation quality can be judged using end-tidal CO
2
, and arterial pressure tracing, with patients turned supine if insufficient.
“…19 , 24 , 26 , 27 , 28 , 30 , 32 , 33 , 35 , 36 The arrest precipitant was incompletely described, but, five patients had air emboli, 26 , 28 , 29 , 33 three had cardiac decompensation, 17 , 25 , 35 three had airway obstruction, 32 , 36 two had excessive parasympathetic stimulation 27 , 32 and one had cardiac tamponade. 31 The most common initial rhythm was pulseless electrical activity (n = 11, 44%), 17 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 32 followed by asystole (n = 4, 16%). 22 , 29 , 33 Refer to Table 2 for summary table of included cases.…”
Section: Resultsmentioning
confidence: 99%
“… Author, year Age Sex Diagnosis Type of surgery Rhythm Confirmation of CPR quality Cause of arrest Outcome (neurological ideally) Al Harbi, 2020 17 80 Male Spine surgery Posterior spinal fusion with laminectomy PEA, asystole ETCO 2 10 mmHg with prone CPR but no palpable pulse. When switched to supine, ETCO 2 increased & had palpable CPR pulses Intraoperative NSTEMI due to hypovolemia Survived Brock-Utne, 2011 18 28 Male Pelvic fractures Open reduction internal fixation PEA Systolic pressures over 80 mmHg (from arterial wave form) Pulmonary embolus Survived (discharged from hospital with intact neurologic status) Burki, 2017 19 6 Female Ventricle tumor excision Posterior cranial fossa PEA Not discussed Hemorrhagic shock ROSC, died 5 days post-surgery Chauhan, 2016 20 49 Male Prolapsed intervertebral disc Lumbar discectomy PEA, asystole Not discussed Unknown Survived Cho, 2010 21 18 Female Congenital posterior scoliosis Deformity correction and fusion with instrumentatio...…”
Section: Resultsmentioning
confidence: 99%
“…Twenty of the 25 cases (80%) were associated with post-resuscitation survival, although few cases included long term outcome. 17 , 18 , 20 , 21 , 22 , 23 , 24 , 26 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 36 The most commonly reported survival endpoint was alive at the end of surgery, 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 34 followed by survival to hospital discharge, 18 , 25 , 28 , 31 and seven cases reported full neurological recovery. 18 , 24 , 30 , 31 , 34 , 35 , 36…”
Aim
To identify and summarize the available science on prone resuscitation. To determine the value of undertaking a systematic review on this topic; and to identify knowledge gaps to aid future research, education and guidelines.
Methods
This review was guided by specific methodological framework and reporting items (PRISMA-ScR). We included studies, cases and grey literature regarding prone position and CPR/cardiac arrest. The databases searched were MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Scopus and Google Scholar. Expanded grey literature searching included internet search engine, targeted websites and social media.
Results
Of 453 identified studies, 24 (5%) studies met our inclusion criteria. There were four prone resuscitation-relevant studies examining: blood and tidal volumes generated by prone compressions; prone compression quality metrics on a manikin; and chest computed tomography scans for compression landmarking. Twenty case reports/series described the resuscitation of 25 prone patients. Prone compression quality was assessed by invasive blood pressure monitoring, exhaled carbon dioxide and pulse palpation. Recommended compression location was zero-to-two vertebral segments below the scapulae. Twenty of 25 cases (80%) survived prone resuscitation, although few cases reported long term outcome (neurological status at hospital discharge). Seven cases described full neurological recovery.
Conclusion
This scoping review did not identify sufficient evidence to justify a systematic review or modified resuscitation guidelines. It remains reasonable to initiate resuscitation in the prone position if turning the patient supine would lead to delays or risk to providers or patients. Prone resuscitation quality can be judged using end-tidal CO
2
, and arterial pressure tracing, with patients turned supine if insufficient.
“…In the prone position, when the operative site is above the level of the heart, venous entrainment of air is likely to occur. 7 Efforts to minimize abdominal compression and thus vena cava pressure in the prone position can result in an increased negative pressure gradient between right atrium and veins at the operative site. This has increased the risk of air entrainment.…”
Cardiac arrest during scoliosis surgery is rare in idiopathic scoliosis. We present a case of cardiorespiratory collapse during corrective surgery in a young patient with idiopathic scoliosis. A diagnosis of venous air embolism was made by exclusion. A cardiorespiratory resuscitation was performed in supine position. Patient recovered without any sequelae and had operation completed 6 weeks later.
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