ABSTRACT
The prone position is a crucial position used in the operating rooms and the intensive care units, with its importance highly recognized during the COVID-19 pandemic in patients with acute respiratory distress syndrome (ARDS). Cardiopulmonary resuscitation (CPR) is a cardinal procedure that is indicated and performed on any eligible patient who has cardiopulmonary arrest and resultant lack of perfusion and oxygenation. When a patient has a cardiopulmonary arrest in the prone position, the options include rotating the patient supine before starting cardiopulmonary resuscitation (CPR) or beginning CPR while prone. Prone CPR has not had a widely accepted use so far. In this article, we narrate the process of protocol development and staff education at our hospital for the initiation of prone CPR and review the literature related to it. Prone CPR is an effective technique with good outcomes and involves a learning curve. Appropriate training needs to be done before implementing the protocol, and adequate quality control measures need to be set to ensure that the skill set is maintained.
ABSTRACT
The most common and recommended position for performing cardiopulmonary resuscitation (CPR) is the supine position. However, clinicians may encounter situations when patients suffer cardiac arrest in prone position. Prone CPR has been described previously in a number of settings, most commonly intraoperative. In the current COVID-19 era, with more patients being nursed in prone position, an increase in the incidence of cardiac arrests requiring prone CPR is expected. Hence most of the resuscitation guidelines have made prone CPR a vital component of their recommendations. To date, most of our health-care workers have limited knowledge about prone resuscitation and the literature surrounding it. Nonetheless, with the current evidence at hand, it seems to be a reliable method of providing resuscitation and all health-care workers should be well versed with it. Thus, the goal of this narrative review is to try and fill the gaps in our knowledge about prone CPR. Literature search was done on PubMed, Medline, EMBASE using keywords 'CPR', 'Resuscitation', 'Prone Position', 'Prone', 'Prone CPR'.
ABSTRACT
INTRODUCTION: The ongoing pandemic of COVID-19 brought to the fore prone positioning as treatment for patients with acute respiratory failure. With the increasing number of patients in prone position, both spontaneously breathing and mechanically ventilated, cardiac arrest in this position is more likely to occur. This scoping review aimed to summarize the available evidence on cardiopulmonary resuscitation in prone position ('reverse CPR') and knowledge or research gaps to be further evaluated. The protocol of this scoping review was prospectively registered on 10th May 2020 in Open Science Framework (https://osf.io/nfuh9). METHODS: We searched PubMed, EMBASE, MEDLINE and pre-print repositories (bioRxiv and medRxiv) for simulation, pre-clinical and clinical studies on reverse CPR until 31st May 2020. RESULTS: We included 1 study on manikins, 31 case reports (29 during surgery requiring prone position) and 2 nonrandomized studies describing reverse CPR. No studies were found regarding reverse CPR in patients with COVID-19. CONCLUSIONS: Even if the algorithms provided by the guidelines on basic and advanced life support remain valid in cardiac arrest in prone position, differences exist in the methods of performing CPR. There is no clear evidence of superiority in terms of effectiveness of reverse compared to supine CPR in patients with cardiac arrest occurring in prone position. The quality of evidence is low and knowledge gaps (e.g. protocols, training of healthcare personnel, devices for skill acquisition) should be fulfilled by further research. Meanwhile, a case-by-case evaluation of patient and setting characteristics should guide the decision on how to start CPR in such cases.