Coronary perfusion pressure and compression quality in maternal cardiopulmonary resuscitation in supine and left-lateral tilt positions: A prospective, crossover study using mannequins and swine models

Abstract

Supine position with left uterine displacement is optimal for maternal CPR.

Effect of Maternal Positioning During Cardiopulmonary Resuscitation: A Systematic Review and Meta-analyses

“…We identi ed no additional articles from the reference lists of the included studies or review articles, and of the 79 articles that underwent full-text evaluation, we excluded 71 for the reasons stated in the PRISMA owchart (Figure 1). A total of eight studies met the inclusion criteria, including six crossover RCTs [36][37][38][39][40][41] and two nonrandomised crossover studies [42,43].…”

“…Of these, one randomised crossover study [39] examined the effect of the manual left uterine displacement in the supine position using a silicone pregnancy bump to simulate a woman in the third trimester of pregnancy and compared the results to those obtained in the left-lateral tilt achieved with a rm wedge. The remaining four randomised crossover studies [36][37][38]40] and one nonrandomised crossover study [42] compared the quality of chest compression on a mannequin lying supine with that of one lying on a 27°-30° left-inclined lateral tilting surface [36][37][38]40] or resting on the thighs of a kneeling assistant ('human wedge') [42]. One randomised crossover study examined the optimal methods for producing lateral tilt comparing soft pillow wedge: rm foam wedge, hard wooden wedge or human wedge [41], and one nonrandomised crossover study [43] examined the effect of chest compression at various angles between 0° and 90° of inclination.…”

“…Of the randomised crossover trials included in this review [36][37][38][39][40][41],none except one [41] reported the processes used to generate the random allocation sequence and/or allocation concealment. Bias due to deviations from intended interventions: Given the nature of the interventions, participants (rescuers) in all studies were aware of their assigned intervention (e.g.…”

“…chest compression in the supine or lateral tilting positions) during each period of the trial. Four studies [36,37,40,41] ensured a washout period to minimise the carryover effect (after 2 minutes of chest compressions in the rst assigned position, the participants rested for 10 minutes to minimise rescuer fatigue), whereas no information was available to assess the carryover effect in the remaining studies [38,39,42,43]. Bias due to missing outcome data: There were no missing outcomes [36- 40,42,43], or the proportion of missing outcomes was small [41].…”

Challenges of Cardiopulmonary Resuscitation during Pregnancy

“…Manual left uterine displacement with the patient supine is comparable to left-lateral tilt in relieving aortocaval compression. 31 Therefore, one can commence resuscitation with manual left uterine displacement in the supine position, using a two-handed technique from the patient's left side or the one-handed technique from the patient's right side depending on the location of the resuscitation team. 32 If this is unsuccessful and an appropriate wedge is available, the patient should be placed in a left-lateral tilt of about 30 degrees using a firm wedge.…”