Technical key points of prone position cardiopulmonary resuscitation(reverse CPR)and analysis of influencing factors of success rate

Xu Yueyuan; Wang Zhiyong; Meng Wenli; Niu Zizhen; Bian Danfeng

doi:10.11986/j.issn.1673-873X.2023.S2.19

Abstract：Objective To summarize the technical key points of prone position cardiopulmonary resuscitation and analyze the factors af-fecting the success of prone position cardiopulmonary resuscitation,providing evidence for clinical practice.Methods By searching lit-erature databases in China and globally,relevant literature that met the inclusion and exclusion criteria was collected.The basic infor-mation of the cases,main diagnosis,main treatment/surgical site(type),situation before and during cardiac arrest(including the ini-tiating and direct causes of cardiac arrest),rescue process(including technical key points),and success of resuscitation(i.e.,restora-tion of spontaneous circulation)were extracted and analyzed.The cases were grouped based on the success of resuscitation,and at-tempts were made to identify influencing factors of successful resuscitation.Results A total of 39 articles and 50 cases were included for data extraction and analysis.During prone position cardiopulmonary resuscitation,if the midline of the back is suitable for compres-sion,the main compression site is the middle thoracic vertebrae(T4-T8).If compression conditions are not met(e.g.,presence of surgical incision),compression on the left and right scapular areas can be considered.There are also reports of placing counterweights between the lower sternum and the prone surface.External defibrillation in a prone position can be used for ventricular fibrillation pa-tients,and the placement of defibrillation electrode pads should be based on the presence of a surgical incision on the back.Electrode pad A can be placed at the midaxillary line of the left fifth intercostal space or slightly forward,and electrode pad S should be placed as close to the upper right side of the heart,near the cardiac apex,as possible.Among the 50 cases,35 cases were successfully resuscita-ted and 15 cases failed,resulting in a success rate of 70％.Regarding the direct causes of cardiac arrest,the success rate of resuscita-tion for rapid ventricular arrhythmia cases(all ventricular fibrillation)was 100％,while the success rate for other cases was only 53.13％,with a statistically significant difference(P＜0.05).Further analysis of the relationship between the initiating causes of car-diac arrest and the success rate of resuscitation revealed that cardiac arrest caused by acute respiratory obstruction was more likely to be successfully resuscitated,while cases caused by air embolism had a significantly lower success rate(P＜0.05).Conclusion In situa-tions where rapid supine positioning of the patient is not feasible,prone position cardiopulmonary resuscitation should be promptly im-plemented,and various related experiences need to be further accumulated in clinical practice and basic research.