Cardiopulmonary resuscitation in prone position: A scoping review

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.

Mortality after in-hospital cardiac arrest in patients with COVID-19: A systematic review and meta-analysis

“… 5 At the same time, cardiopulmonary resuscitation of a patient with COVID-19 carries inherent risks for healthcare workers as resuscitation procedures may disperse aerosol. 6 , 7 Much public and scientific debate has therefore surrounded the ethics of CPR and do-not-attempt resuscitation (DNAR) orders in patients with COVID-19. 8 At this time, the rates of mortality and other relevant clinical outcomes in patients with COVID-19 after IHCA remain unclear and the data surrounding this topic is fragmented.…”

Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers

“…In case of cardiac arrest in a prone position, “reverse cardiopulmonary resuscitation (CPR)” 39 , 40 can and must be started until a team is available to turn the patient back to supine. 41 This team should be identified and always be readily available.…”

“…In case of cardiac arrest in a prone position, "reverse cardiopulmonary resuscitation (CPR)" 39,40 can and must be Crash cart (intubation equipment) available and know where to find BP = blood pressure; HR = heart rate; IV = intravenous; RR = respiratory rate; SpO2 = peripheral oxygen saturation. Based on the WHO surgical checklist and Safe prone checklist.…”

Reanimación cardiopulmonar en prono a propósito de un caso

“…Según publica Nunnally, del total de las PCR que ocurren en el transoperatorio, el 2,76% ocurren en las cirugías de columna [2]. Entre las posibles causas de PCR en decúbito prono durante la cirugía de columna encontramos: el embolismo aéreo, compromiso del retorno venoso, hipovolemia e hipoxemia por extubación accidental [8]. A día de hoy, las maniobras de RCP en prono presentan mucha menor evidencia que las maniobras de RCP convencionales.…”

“…Sin embargo, la maniobra de supinación una vez el paciente esta colocado y fijado, además de consumir tiempo y ser técnicamente compleja, no está exenta de riesgos [8]. Desde el 2005, las guías americanas recogen la posibilidad de iniciar las maniobras de RCP en prono cuando el paciente no puede ser colocado en decúbito supino de forma inmediata [11], [12].…”