Performing CPR on Prone Position Patients
Published: 26 April 2020
Published: 26 April 2020
With nurses of all backgrounds potentially being required to work in critical care environments due to the COVID-19 pandemic, you may encounter patients who are being nursed in a prone position. As well as understanding how to care for a patient in prone position, you should also know how to perform CPR on them in the event of deterioration.
Patients experiencing respiratory distress may be manoeuvered into the prone position for the delivery of ventilation if other methods have proven unsuccessful (Malhotra & Kacmarek 2019). The prone position may also be used for patients undergoing spinal surgery or neurosurgery (Kaur et al. 2016).
These patients may begin to deteriorate or experience cardiac arrest, requiring immediate cardiopulmonary resuscitation (CPR) (Nanjangud & Nileshwar 2017). In some circumstances, though it is not ideal, CPR may need to be performed while the patient is still in a prone position.
Prone CPR is uncommon and unusual, as it is not a preferable position for resuscitation. A face-down patient impedes access to the airway and veins, posing a significant challenge to those performing the resuscitation (Bhatnagar et al. 2018; Nanjangud & Nileshwar 2017).
However, even though the supine position is considered optimal for CPR, and supine CPR is easier, it is not always feasible to manoeuvre a patient from prone to supine before commencing resuscitation (Kaur et al. 2016; Nanjangud & Nileshwar 2017):
(Nanjangud & Nileshwar 2017; Intensive Care Society 2019; Saracoglu & Saracoglu 2018)
The American Heart Association (2010) consider it ‘reasonable’ to provide CPR to a patient in the prone position (particularly if they have an advanced airway in place) if they cannot be placed into the supine position. However, this advice has not been reviewed since 2010 (Ah Harbi et al. 2020).
Furthermore, in the event of arrest during neurosurgery, the Resuscitation Council (2014) advises that chest compressions and/or defibrillation should be commenced immediately, without changing the patient’s position.
For these reasons, CPR may need to be performed on a patient in the prone position in some circumstances, or at least until they can be manoeuvered into the supine position (Nanjangud & Nileshwar 2017).
Despite the infrequency of prone CPR, there have been a handful of successful resuscitations detailed in case reports (Bhatnagar et al. 2018).
In all of these cases, the patient was being mechanically ventilated and invasively monitored with an advanced airway already secured prior to deterioration. Successful cases demonstrated compressions being performed on the thoracic spine with the same rate and force as compressions that would be delivered in the supine position (Bhatnagar et al. 2018).
It has been concluded that if resuscitation is commenced immediately, and the cause of arrest is simultaneously addressed, CPR in the prone position can generate a sufficient cardiac output (Kaur 2016).
(Al Harbi 2020; Intensive Care Society 2019; Saracoglu & Saracoglu 2018; Bhatnagar et al. 2018; Feix & Sturgess 2014)
Complications from poor positioning may lead to an increase in mortality or morbidity rates. Other complications may include:
(Feix & Sturgess 2014)
Despite being a relatively uncommon procedure, prone CPR has been proven successful if the situation is attended to immediately.
If a patient goes into cardiac arrest while in a prone position, and a manoeuvre is not feasible, it is best to begin CPR immediately and reposition the patient later if required. Ensure you apply sternal counter pressure to the patient.
Note: This article is intended as supplementary learning and should not replace best-practice care. Always ensure your advanced and basic life support training is up to date and that you refer to your organisation’s policy on performing CPR.
Question 1 of 3
True or false? The prone position is preferable for performing CPR.
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