Cardiopulmonary resuscitation in the prone position

Abstract

Cardiopulmonary resuscitation (CPR) is a series of life-saving procedures aimed at restoring and maintaining the functions of breathing and circulation in patients suffering from cardio-respiratory arrest. Old and new CPR guidelines assume that the patient is lying on the back, on a hard and stable surface. The prone position where the patient is lying on the stomach is often used in the operating room to enable an easier approach to the operative field and in intensive care units (ICU) to enable better oxygenation for patients in advanced stages of hypoxic respiratory insufficiency. During the COVID-19 pandemic, patients suffering from the infection are often treated in the prone position. Should cardiac arrest occur, it is necessary to initiate high-quality chest compressions and early defibrillation as soon as possible for the patient to have the best chance of survival. Current guidelines stipulate that CPR should be initiated immediately, even in the prone position, and kept up until conditions are met for the patient to be turned over onto the back. It is recommended to place hands on the patient's back at the level of the T7-T10 vertebrae and perform chest compressions with the usual strength and velocity (5-6 cm deep, 2 compressions per second). For defibrillation, self-adhesive disposable electrodes should be placed in an anterior-posterior or a bi-axillary position. Sternal counterpressure could increase the efficacy of chest compressions. Educating health workers to perform this CPR technique and using it in selected patients can increase survival.