Cardiopulmonary resuscitation in prone position: a simplified method for outpatients.

Abstract

Effective cardiopulmonary resuscitation is vital for life saving of victims with sudden cardiac arrest. Kuowenhoven and colleagues proposed in 1960 what has become the standard method of cardiopulmonary resuscitation (CPR) [[1]Kuowenhoven W.B Jude J.R Knickerbocker G.G Closed chest cardiac massage.JAMA. 1960; 173: 1064-1067Crossref PubMed Scopus (1324) Google Scholar]. Despite vast input of resources for public education and training in this procedure, its success rate outside hospital remains poor to dismal. Attempts had been exerted to simplify the techniques. The idea of CPR in prone position was first mentioned by McNeil in 1989 and was reinforced by Stewart in 2002 [2McNeil E Re-evaluation of cardiopulmonary resuscitation.Resuscitation. 1989; 18: 1-5Abstract Full Text PDF PubMed Scopus (24) Google Scholar, 3Stewart J Resuscitating an idea: prone CPR.Resuscitation. 2002; 54: 231Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar]. Recently the Columbia group have reported that compression on the back of patients would generate a higher blood pressure than conventional CPR [[4]Mazer SP, Weisfeldt M, Bai D, et al. Reverse CPR: a pilot study of CPR in the prone position. Resuscitation 2003;279–85.Google Scholar]. From 2000 to 2002, we have also performed a study on five patients who had a cardiac arrest in ICU. All received conventional CPR before death. After the attempt was abandoned they were turned over to the prone position with the arterial pressure line still in place. The head was turned to one side. Compression of the thoracic spine was performed and the blood pressure value and tracing was recorded. This manoeuvre generated a mean systolic pressure of 95±19 mmHg and diastolic pressure of 25±10 mmHg. Ten healthy volunteers were also enlisted for ventilatory assessment during compression on the back. The volunteer’s exhaled tidal volume upon compression was measured with a spirometer and recorded. The same manoeuvre generated a mean tidal volume of 398.5±109.9 ml. Our brief study revealed that CPR in the prone position meets the requirements of circulatory and ventilatory support and is clinically effective. It is very simple and appears to be suitable for training laymen to perform resuscitation in public surroundings. Effective cardiopulmonary resuscitation is vital for life saving of victims with sudden cardiac arrest. Kuowenhoven and colleagues proposed in 1960 what has become the standard method of cardiopulmonary resuscitation (CPR) [[1]Kuowenhoven W.B Jude J.R Knickerbocker G.G Closed chest cardiac massage.JAMA. 1960; 173: 1064-1067Crossref PubMed Scopus (1324) Google Scholar]. Despite vast input of resources for public education and training in this procedure, its success rate outside hospital remains poor to dismal. Attempts had been exerted to simplify the techniques. The idea of CPR in prone position was first mentioned by McNeil in 1989 and was reinforced by Stewart in 2002 [2McNeil E Re-evaluation of cardiopulmonary resuscitation.Resuscitation. 1989; 18: 1-5Abstract Full Text PDF PubMed Scopus (24) Google Scholar, 3Stewart J Resuscitating an idea: prone CPR.Resuscitation. 2002; 54: 231Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar]. Recently the Columbia group have reported that compression on the back of patients would generate a higher blood pressure than conventional CPR [[4]Mazer SP, Weisfeldt M, Bai D, et al. Reverse CPR: a pilot study of CPR in the prone position. Resuscitation 2003;279–85.Google Scholar]. From 2000 to 2002, we have also performed a study on five patients who had a cardiac arrest in ICU. All received conventional CPR before death. After the attempt was abandoned they were turned over to the prone position with the arterial pressure line still in place. The head was turned to one side. Compression of the thoracic spine was performed and the blood pressure value and tracing was recorded. This manoeuvre generated a mean systolic pressure of 95±19 mmHg and diastolic pressure of 25±10 mmHg. Ten healthy volunteers were also enlisted for ventilatory assessment during compression on the back. The volunteer’s exhaled tidal volume upon compression was measured with a spirometer and recorded. The same manoeuvre generated a mean tidal volume of 398.5±109.9 ml. Our brief study revealed that CPR in the prone position meets the requirements of circulatory and ventilatory support and is clinically effective. It is very simple and appears to be suitable for training laymen to perform resuscitation in public surroundings.