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. 2021 Feb 1;132(2):285-292.
doi: 10.1213/ANE.0000000000005289.

Cardiopulmonary Resuscitation in the Prone Position in the Operating Room or in the Intensive Care Unit: A Systematic Review

Cristobal Anez  1   2 , Ángel Becerra-Bolaños  3 , Ariadna Vives-Lopez  1   2 , Aurelio Rodríguez-Pérez  3   4
Affiliations

Cardiopulmonary Resuscitation in the Prone Position in the Operating Room or in the Intensive Care Unit: A Systematic Review

Cristobal Anez et al. Anesth Analg. .

Abstract

The prone position is commonly used in certain surgical procedures and to improve oxygenation in mechanically ventilated patients with acute respiratory distress syndrome (ARDS). Cardiorespiratory arrest (CRA) in this position may be more challenging to treat because care providers trained in conventional cardiopulmonary resuscitation (CPR) may not be familiar with CPR in the prone position. The aim of this systematic review is to provide an overview of current evidence regarding the methodology, efficacy, and experience of CPR in the prone position, in patients with the airway already secured. The search strategy included PubMed, Scopus, and Google Scholar. All studies published up to April 2020 including CRA or CPR in the prone position were included. Of the 268 articles located, 52 articles were included: 5 review articles, 8 clinical guidelines in which prone CPR was mentioned, 4 originals, 27 case reports, and 8 editorials or correspondences. Data from reviewed clinical studies confirm that CPR in the prone position is a reasonable alternative to supine CPR when the latter cannot be immediately implemented, and the airway is already secured. Defibrillation in the prone position is also possible. Familiarizing clinicians with CPR and defibrillation in the prone position may improve CPR performance in the prone position.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram. PRISMA indicates Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2.
Location where compressions are recommended to be performed in the prone position. Red line represents location of compressions. Black line represents inferior scapular limit.
Figure 3.
Figure 3.
Location where defibrillation pads should be placed in the prone position.
See this image and copyright information in PMC

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