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. 2020 Nov;38(11):2416-2424.
doi: 10.1016/j.ajem.2020.08.097. Epub 2020 Sep 10.

Cardiopulmonary resuscitation in prone position: A scoping review

Alessandra Moscarelli  1 , Pasquale Iozzo  2 , Mariachiara Ippolito  1 , Giulia Catalisano  1 , Cesare Gregoretti  3 , Antonino Giarratano  4 , Enrico Baldi  5 , Andrea Cortegiani  6
Affiliations

Cardiopulmonary resuscitation in prone position: A scoping review

Alessandra Moscarelli et al. Am J Emerg Med. 2020 Nov.

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.

Keywords: COVID-19; Prone CPR; Prone position; Reverse CPR.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram. The figure shows the inclusion/exclusion process with details, as appropriate.
Fig. 2
Fig. 2
Suggested positions for defibrillator pads placement. The figure shows the positions of defibrillator pads, as described in available literature. Panel a) antero-posterior placement; panel b) bi-axillary placement; panel c) postero-lateral placement.
Fig. 3
Fig. 3
Suggested position of rescuer's hands in reverse cardiopulmonary resuscitation. The figure shows the position of rescuer's hands, as described in available literature, for compressions during reverse cardiopulmonary resuscitation. Panel a) midline position; panel b) lateral position; c) one-hand technique with sternal counterpressure.
See this image and copyright information in PMC

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