Prone cardiopulmonary resuscitation: A scoping and expanded grey literature review for the COVID-19 pandemic

Abstract

Aim To identify and summarize the available science on prone resuscitation. To determine the value of undertaking a systematic review on this topic; and to identify knowledge gaps to aid future research, education and guidelines. Methods This review was guided by specific methodological framework and reporting items (PRISMA-ScR). We included studies, cases and grey literature regarding prone position and CPR/cardiac arrest. The databases searched were MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Scopus and Google Scholar. Expanded grey literature searching included internet search engine, targeted websites and social media. Results Of 453 identified studies, 24 (5%) studies met our inclusion criteria. There were four prone resuscitation-relevant studies examining: blood and tidal volumes generated by prone compressions; prone compression quality metrics on a manikin; and chest computed tomography scans for compression landmarking. Twenty case reports/series described the resuscitation of 25 prone patients. Prone compression quality was assessed by invasive blood pressure monitoring, exhaled carbon dioxide and pulse palpation. Recommended compression location was zero-to-two vertebral segments below the scapulae. Twenty of 25 cases (80%) survived prone resuscitation, although few cases reported long term outcome (neurological status at hospital discharge). Seven cases described full neurological recovery. Conclusion This scoping review did not identify sufficient evidence to justify a systematic review or modified resuscitation guidelines. It remains reasonable to initiate resuscitation in the prone position if turning the patient supine would lead to delays or risk to providers or patients. Prone resuscitation quality can be judged using end-tidal CO 2 , and arterial pressure tracing, with patients turned supine if insufficient.

Deciding to post a manuscript preprint

“…Duoma et al 9,10 . had a similarly positive experience posting a scoping review on medRxiv; this manuscript received media attention after the preprint posting.…”

Cardiopulmonary Arrest and Resuscitation in the Prone Patient: An Adult Simulation Case for Internal Medicine Residents

“…Over the course of the past several months, it is now increasingly likely that cardiopulmonary arrests will occur in the prone position, 22 and there has been a call for more evaluation, education, and guidance when completing CPR in the prone position in patients with COVID-19. [22][23][24] Though our simulation does not involve a COVID-positive patient, we believe that it provides a basic framework upon which to build when considering prone CPR in any patient.…”

Commentary on “Prone Positioning of Patients With Coronavirus Disease 2019 Who Are Nonintubated in Hypoxic Respiratory Distress”

“… 6 Be aware that cardiac arrests do occur in the prone position, they may be more difficult to detect, 23 and they will require a plan to initiate resuscitation that may or may not include immediately rolling them supine. 24 We recognize that this is an emerging field of research and that clinical practice will be largely dictated by local governance and judgment.…”