Cardiopulmonary Resuscitation in the Prone Position

Gomes, Daiana de Souza; Bersot, Carlos Darcy Alves

doi:10.4236/ojanes.2012.25045

Cited by 23 publications

(13 citation statements)

References 9 publications

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“…Survival to hospital discharge with favourable neurological outcome was not explicitly reported in any adult or paediatric case. There were implicit reports of survival to hospital discharge with favourable neurological outcome in eight adult cases (‘without neurologic deficit’ 21 ; ‘no cerebral injury’ 20 ; ‘recovered uneventfully’ 23 ; ‘without deficits’ 33 ; ‘awake and well oriented at 7 days’ 22 ; ‘without sequelae’ 24 ; ‘could carry out simple tasks’ 25 ; and ‘discharged from hospital in a stable neurological condition’ 30 ) and seven paediatric cases (‘no evidence of significant cerebral dysfunction’ 38 ; ‘returned to baseline over two weeks’ 39 ; ‘recovered without sequelae’ 40 ; ‘no adverse neurological sequelae’ 41 ; ‘in good condition’ 47 ; ‘made an uneventful recovery’ 29 ; and ‘unchanged from preoperative status’ 42 ).…”

Section: Resultsmentioning

confidence: 99%

Cardiopulmonary resuscitation and defibrillation for cardiac arrest when patients are in the prone position: A systematic review

et al. 2021

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Aim To perform a systematic review of cardiopulmonary resuscitation (CPR) and/or defibrillation in the prone position compared to turning the patient supine prior to starting CPR and/or defibrillation. Methods The search included PubMed, Embase, Web of Science, Cochrane, CINAHL Plus, and medRxiv on December 9, 2020. The population included adults and children in any setting with cardiac arrest while in the prone position. The outcomes included arterial blood pressure and end-tidal capnography during CPR, time to start CPR and defibrillation, return of spontaneous circulation, survival and survival with favorable neurologic outcome to discharge, 30 days or longer. ROBINS-I was performed to assess risk of bias for observational studies. Results The systematic review identified 29 case reports (32 individual cases), two prospective observational studies, and two simulation studies. The observational studies enrolled 17 patients who were declared dead in the supine position and reported higher mean systolic blood pressure from CPR in prone position (72 mmHg vs 48 mmHg, p < 0.005; 79 ± 20 mmHg vs 55 ± 20 mmHg, p = 0.028). One simulation study reported a faster time to defibrillation in the prone position. Return of spontaneous circulation, survival to discharge or 30 days were reported in adult and paediatric case reports. Critical risk of bias limited our ability to perform pooled analyses. Conclusions We identified a limited number of observational studies and case reports comparing prone versus supine CPR and/or defibrillation. Prone CPR may be a reasonable option if immediate supination is difficult or poses unacceptable risks to the patient.

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Section: Resultsmentioning

confidence: 99%

Cardiopulmonary resuscitation and defibrillation for cardiac arrest when patients are in the prone position: A systematic review

et al. 2021

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“… 22 Gomes and Bersot reported successful prone CPR in a neurosurgical patient, using compression over the mid-thoracic level, but no sternal counter-pressure. 44 Kwon et al reviewed 100 chest CTs to determine where to compress the largest left ventricular mass. Once again, it was mid-thoracic, below the inferior angle of the scapulae.…”

Section: Discussionmentioning

confidence: 99%

Prone cardiopulmonary resuscitation: A scoping and expanded grey literature review for the COVID-19 pandemic

Douma

Mackenzie²,

Loch

et al. 2020

Resuscitation

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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.

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“…[22] Gomes et al reported successful prone CPR in a neurosurgical patient, using compression over the mid-thoracic level, but no sternal counter-pressure. [44] Kwon et al reviewed 100 chest CTs to determine where to compress the largest left ventricular mass. Once again, it was mid-thoracic, below the inferior angle of the scapulae.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Dequin et al reported successful prone CPR in an ICU patient, in which they used two-handed mid-thoracic compression and a second person for sternal counter-pressure [22]. Gomes et al reported successful prone CPR in a neurosurgical patient, using compression over the mid-thoracic level, but no sternal counter-pressure [44]. Kwon et al reviewed 100 chest CTs to determine where to compress the largest left ventricular mass.…”

mentioning

confidence: 99%

Prone Cardiopulmonary Resuscitation: A Rapid Scoping and Expanded Grey Literature Review for the covid-19 Pandemic

Douma

Mackenzie²,

Loch

et al. 2020

Preprint

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Prone Cardiopulmonary Resuscitation: A Rapid Scoping and Expanded Grey Literature Review for the COVID-19 Pandemic Aim To rapidly 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. 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 CO2, and arterial pressure tracing, with patients turned supine if insufficient. Key words CPR, prone, cardiopulmonary resuscitation, Scoping review, Resuscitation, covid-19, SARS-CoV-2

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Cardiopulmonary Resuscitation in the Prone Position

Cited by 23 publications

References 9 publications

Cardiopulmonary resuscitation and defibrillation for cardiac arrest when patients are in the prone position: A systematic review

Cardiopulmonary resuscitation and defibrillation for cardiac arrest when patients are in the prone position: A systematic review

Prone cardiopulmonary resuscitation: A scoping and expanded grey literature review for the COVID-19 pandemic

Prone Cardiopulmonary Resuscitation: A Rapid Scoping and Expanded Grey Literature Review for the covid-19 Pandemic

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