Prone cardiopulmonary resuscitation: an intensive care unit case series

Abstract

Background: Critically ill patients frequently receive mechanical ventilation in the prone position. If hypoxic respiratory failure progresses, pulseless events requiring emergent cardiopulmonary resuscitation may occur. Administering cardiopulmonary resuscitation in the prone position provides an opportunity to initiate chest compressions quickly, eliminating delays in resuscitative efforts. Case Description: Three cases of patients with extended hospital stays who received prone cardiopulmonary resuscitation for pulseless electrical activity arrests while in the Medical Intensive Care Unit are reviewed. All three patients achieved return of spontaneous circulation for a period of time during their resuscitative efforts. Additionally, patients obtained either adequate end-tidal carbon dioxide levels or appropriate arterial line waveforms demonstrating administration of adequate compressions with prone cardiopulmonary resuscitation. Ultimately all three patients did not survive, but this is most likely attributable to their underlying conditions and severity of disease rather than the adequacy of prone cardiopulmonary resuscitation. Conclusions: Although there is a paucity of literature, prone cardiopulmonary resuscitation provides an opportunity to eliminate delays and initiate immediate resuscitative efforts in critically ill patients who experience a pulseless event while in the prone position. Current guidance from the American Heart Association recommends initiating cardiopulmonary resuscitation in the prone position if an advanced airway is present and it is unsafe to move the patient into the supine position. Defibrillator pads should be placed in the anterior-posterior position and compressions should be administered with hands over the T7/10 vertebral bodies. The administration of high-quality cardiopulmonary resuscitation should be guided by the monitoring of end-tidal carbon dioxide or via arterial lines. While more quality literature is needed to fully establish clinical outcomes, prone cardiopulmonary resuscitation should be implemented within the intensive care unit to eliminate resuscitative delays in patients who have a pulseless event while in the prone position.