Prone Cardiopulmonary Resuscitation

ABSTRACT

The delivery of mechanical ventilation in the prone position in intensive care unit (ICU) patients has been shown to improve oxygenation in patients with severe acute respiratory distress syndrome (ARDS). In addition, prone positioning improves alveoli recruitment and optimizes ventilation-perfusion match through the reduction of lung compression and increased lung perfusion. Outside the ICU, prone positioning may be necessary during surgical procedures, particularly involving the posterior anatomical structures, to ease access. Patients managed in the prone position either due to acute respiratory failure or during surgery may suffer cardiac arrest. Given that the goal of CPR is to reduce the time of limited to no blood flow to the brain, switching patients from prone to supine positions is likely to cause a detrimental delay in initiating CPR leading to poor outcomes. According to the 2010 American Heart Association (AHA) guidelines on cardiopulmonary resuscitation (CPR) and emergency cardiovascular critical care (ECC), it may be reasonable for providers to initiate CPR while in a prone position if the patient cannot be placed in a supine position. This article will provide more insight into the indications, current evidence, technique, and the role of the interprofessional cardiac arrest teams in providing optimal prone CPR.