SlideShare a Scribd company logo
1 of 21
Download to read offline
DR. YOGESH RATHOD
DEPARTMENT OF ANAESTHESIOLOGY,
SETH GSMC & KEM HOSPITAL, PAREL,
MUMBAI.
Guidelines and changes of 2015
ACLS
When the patient cannot be placed in the supine
position, it may be reasonable for rescuers to provide
CPR with the patient in the prone position, particularly
in hospitalized patients with an advanced airway in place
(ClassIIb, LOE C).
NOT REVIEWED IN 2015
Prone cpcr
Prone cpcr
Prone cpcr
EFFICACY OF CPCR IN PRONE POSITION
Efficient CPCR can be performed on a
mannequin in the prone position, although
additional instructions in technique is
required. This may be applicable to patients
turned to the prone position.
(Critical Care & Resuscitation 2000;2:188-190)
 The first case report of successful CPR in the
prone position was described by Sun et al. in
1992. Two neurosurgical cases of CPR after
acute hypovolemia.
 “REVERSE PRECORDIAL COMPRESSION
MANEUVER”
 One hand placed on the back of the patient, in
the mid-thoracic spine & other hand placed on
the lower third of the sternum serving as
counter-pressure to the compression of the
back
Prone cpcr
Brown et al. reported a systematic review
of literature and found only 22 cases of
CPR in the prone position published from
1966 to 1999, with survival of 10 patients
[6]. Since then, few cases have reported
prone CPR in database Medline (2000-
2010)
•Beltran et al. present two cases of
cardiopulmonary arrest and unsuccessful
attempts at resuscitation after repositioning
supine.
•The surgical site of bleeding became
inaccessible after repositioning.
•Prone resuscitation would have provided a
better alternative.
•Miranda et al. described a case in which electrical
defibrillation was successfully performed in the prone
position in a patient undergoing complex spinal
surgery.
•They suggest that, if defibrillation were required in
ventilated patients positioned prone, defibrillation
should be attempted in the prone position, as turning
the patient supine would consume valuable minutes
and reduce the chances of successful defibrillation .
•No specific recommendation on the frequency
and depth of compressions to the patient in the
prone position.
•The frequency maintained above 100 cpm and
depth sufficient to produce good perfusion
indicators but without generating instability
between the thoracic and cervical spine, which
was fixed by Manfield head-holder.
American Heart Association, “2010 American Heart As-sociation Guidelines for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care,” Circulation, Vol. 122, No. 18, 2010, p. 721.
“Is the Upside-down Position Better in
Cardiopulmonary Resuscitation?”
Huey Wen Yien & Wei
National Yang Ming University of Medicine & Taipei Veterans
General Hospital, Taiwan.
(J China Med Assoc, May 2006, vol 69, No 5)
P-CPR: 79 ± 20/ 17 ±10 mmHg. M.T.Volume: 300 ± 110 ml.
S-CPR: 55 ± 20/ 13 ± 7 mmHg.
Conclusions: In some case reports of higher mean blood
pressure and intrathoracic pressure, prone CPR may be
initiated in a well controlled environment, such as the OR or
ICU, to avoid delay in onset of CPR. (Class I, Grade B)
Prone CPR is performed frequently in the operating
room (OR) on patients
• Spine surgeries- deformity corrections
• Neurosurgery
• other surgical procedures on the back
In some situations in the intensive care unit (ICU)
•Adult respiratory distress syndrome(ARDS)
where all patients are intubated and ventilated
PRONE under full-monitoring support.
•The first pilot study that documented a higher blood
pressure using prone CPR was published by Mazer et al
in 2003.
•The first systematic review of 16 articles, written by
Brown et al in 2001, documented that there were a total
of 22 intubated hospitalized patients who received CPR
in the prone position, and 10 of them survived to
discharge.
•Although Stewart emphasized that prone CPR was
superior to standard CPR, there is currently no evidence
to prove a beneficial outcome.
When prone CPR was performed
•sternal support with sandbags
•gel-filled pads
•500-mL bags of IV fluid was suggested.
•The thoracic pump model supported prone CPR more than
the cardiac pump model.
•Increased intrathoracic pressure and systolic blood pressure
in 6 cases resuscitated with rhythmic back pressure and
sternal counterpressure in the prone position.
•A unique mechanism to support this effect is that less
anterior displacement of the abdomen during thoracic
compressions could enhance the efficiency of CPR effort
Hypothetical Benefits and
Limitations of Prone CPR
Clinical trials of CPR in hospitalized
patients or out-of-hospital victims are
challenging because interventions must
frequently be implemented at a time when
informed consent is almost impossible to
obtain.
Stewart JA. Resuscitating an idea: prone CPR. Resuscitation 2002;53:231–6.
Current Evidences and Guidelines of
2005 ACLS
The 2005 American Heart Association (AHA) Guidelines for CPR
and Emergency Cardiovascular Care (ECC)1 did not endorse the
prone position as the standard CPR.
It is accepted only as a less-than optimal alternative to supine
CPR in certain situations.
The recommendation is that “when the patient cannot be placed
in the supine position, rescuers may consider providing CPR with
the patient in the prone position, particularly in hospitalized
patients with an advanced airway in place” (Level of evidence 5;
Class IIb)
The leader of a resuscitation team should adapt the guidelines to
specific circumstances.
Prone CPR may be initiated in a well
controlled environment, such as the OR
or ICU, to avoid delay in onset of CPR.
As in bystander CPR for unconscious and
unintubated persons, further evidence-
based trials of prone CPR should be
expected before becoming an alternative
practice
THANK
YOU

More Related Content

What's hot

MANAGEMENT OF DIFFICULT AIRWAY
MANAGEMENT OF DIFFICULT AIRWAYMANAGEMENT OF DIFFICULT AIRWAY
MANAGEMENT OF DIFFICULT AIRWAYBivash Halder
 
Application of simulation in anesthesia Application of simulation in anesth...
Application of simulation in anesthesia 	 Application of simulation in anesth...Application of simulation in anesthesia 	 Application of simulation in anesth...
Application of simulation in anesthesia Application of simulation in anesth...MedicineAndHealth
 
Extubation problems and its management
Extubation problems and its managementExtubation problems and its management
Extubation problems and its managementDr Kumar
 
2022 ASA Airway.ppt
2022 ASA Airway.ppt2022 ASA Airway.ppt
2022 ASA Airway.pptMSKsha
 
High flow nasal cannula (hfnc) linkden
High flow nasal cannula (hfnc) linkdenHigh flow nasal cannula (hfnc) linkden
High flow nasal cannula (hfnc) linkdenAhmed AlGahtani, RRT
 
High flow nasal cannula (hfnc) by Tarfa Al-Sabhan
High flow nasal cannula (hfnc) by Tarfa Al-Sabhan High flow nasal cannula (hfnc) by Tarfa Al-Sabhan
High flow nasal cannula (hfnc) by Tarfa Al-Sabhan Maher AlQuaimi
 
High Frequency Ventillation
High Frequency VentillationHigh Frequency Ventillation
High Frequency VentillationDr.Mahmoud Abbas
 
Recruitment maneuvers in ards
Recruitment maneuvers in ardsRecruitment maneuvers in ards
Recruitment maneuvers in ardsAnusha Jahagirdar
 
Pulmonary artery catheter
Pulmonary artery catheterPulmonary artery catheter
Pulmonary artery catheterArun Aru
 
ADVANCED AIRWAY MANAGEMENT IN THE INTENSIVE CARE UNIT: FUNDAMENTALS OF INTUBA...
ADVANCED AIRWAY MANAGEMENT IN THE INTENSIVE CARE UNIT:FUNDAMENTALS OF INTUBA...ADVANCED AIRWAY MANAGEMENT IN THE INTENSIVE CARE UNIT:FUNDAMENTALS OF INTUBA...
ADVANCED AIRWAY MANAGEMENT IN THE INTENSIVE CARE UNIT: FUNDAMENTALS OF INTUBA...Bassel Ericsoussi, MD
 
Respiratory function and importance to anesthesia final
Respiratory function and importance to anesthesia  finalRespiratory function and importance to anesthesia  final
Respiratory function and importance to anesthesia finalDrUday Pratap Singh
 
Weaning from mechanical ventilation
Weaning from mechanical ventilationWeaning from mechanical ventilation
Weaning from mechanical ventilationmauryaramgopal
 
Low flow Anaesthesia & Gas Monitoring
Low flow Anaesthesia & Gas MonitoringLow flow Anaesthesia & Gas Monitoring
Low flow Anaesthesia & Gas MonitoringKalpesh Shah
 
Essentials of Pediatric Anesthesia
Essentials of Pediatric AnesthesiaEssentials of Pediatric Anesthesia
Essentials of Pediatric AnesthesiaAalap Shah
 
ANESTHESIA MANAGEMENT OF CLEFT LIP & PALATE
ANESTHESIA MANAGEMENT OF CLEFT LIP & PALATEANESTHESIA MANAGEMENT OF CLEFT LIP & PALATE
ANESTHESIA MANAGEMENT OF CLEFT LIP & PALATEmadhu chaitanya
 

What's hot (20)

MANAGEMENT OF DIFFICULT AIRWAY
MANAGEMENT OF DIFFICULT AIRWAYMANAGEMENT OF DIFFICULT AIRWAY
MANAGEMENT OF DIFFICULT AIRWAY
 
Post extubation stridor
Post extubation stridorPost extubation stridor
Post extubation stridor
 
Prone position
Prone positionProne position
Prone position
 
Application of simulation in anesthesia Application of simulation in anesth...
Application of simulation in anesthesia 	 Application of simulation in anesth...Application of simulation in anesthesia 	 Application of simulation in anesth...
Application of simulation in anesthesia Application of simulation in anesth...
 
Extubation problems and its management
Extubation problems and its managementExtubation problems and its management
Extubation problems and its management
 
2022 ASA Airway.ppt
2022 ASA Airway.ppt2022 ASA Airway.ppt
2022 ASA Airway.ppt
 
High flow nasal cannula (hfnc) linkden
High flow nasal cannula (hfnc) linkdenHigh flow nasal cannula (hfnc) linkden
High flow nasal cannula (hfnc) linkden
 
High flow nasal cannula (hfnc) by Tarfa Al-Sabhan
High flow nasal cannula (hfnc) by Tarfa Al-Sabhan High flow nasal cannula (hfnc) by Tarfa Al-Sabhan
High flow nasal cannula (hfnc) by Tarfa Al-Sabhan
 
High Frequency Ventillation
High Frequency VentillationHigh Frequency Ventillation
High Frequency Ventillation
 
Pre-oxygenation
Pre-oxygenationPre-oxygenation
Pre-oxygenation
 
Ventilator Graphics
Ventilator GraphicsVentilator Graphics
Ventilator Graphics
 
Recruitment maneuvers in ards
Recruitment maneuvers in ardsRecruitment maneuvers in ards
Recruitment maneuvers in ards
 
Pulmonary artery catheter
Pulmonary artery catheterPulmonary artery catheter
Pulmonary artery catheter
 
ADVANCED AIRWAY MANAGEMENT IN THE INTENSIVE CARE UNIT: FUNDAMENTALS OF INTUBA...
ADVANCED AIRWAY MANAGEMENT IN THE INTENSIVE CARE UNIT:FUNDAMENTALS OF INTUBA...ADVANCED AIRWAY MANAGEMENT IN THE INTENSIVE CARE UNIT:FUNDAMENTALS OF INTUBA...
ADVANCED AIRWAY MANAGEMENT IN THE INTENSIVE CARE UNIT: FUNDAMENTALS OF INTUBA...
 
Respiratory function and importance to anesthesia final
Respiratory function and importance to anesthesia  finalRespiratory function and importance to anesthesia  final
Respiratory function and importance to anesthesia final
 
Extubation
Extubation Extubation
Extubation
 
Weaning from mechanical ventilation
Weaning from mechanical ventilationWeaning from mechanical ventilation
Weaning from mechanical ventilation
 
Low flow Anaesthesia & Gas Monitoring
Low flow Anaesthesia & Gas MonitoringLow flow Anaesthesia & Gas Monitoring
Low flow Anaesthesia & Gas Monitoring
 
Essentials of Pediatric Anesthesia
Essentials of Pediatric AnesthesiaEssentials of Pediatric Anesthesia
Essentials of Pediatric Anesthesia
 
ANESTHESIA MANAGEMENT OF CLEFT LIP & PALATE
ANESTHESIA MANAGEMENT OF CLEFT LIP & PALATEANESTHESIA MANAGEMENT OF CLEFT LIP & PALATE
ANESTHESIA MANAGEMENT OF CLEFT LIP & PALATE
 

Viewers also liked

AHA Response to 2015 IOM Cardiac Arrest Report
AHA Response to 2015 IOM Cardiac Arrest ReportAHA Response to 2015 IOM Cardiac Arrest Report
AHA Response to 2015 IOM Cardiac Arrest ReportBrian Eigel, PhD
 
Smart ICU project. Dr.Francisco Murillo_English version
Smart ICU project. Dr.Francisco Murillo_English versionSmart ICU project. Dr.Francisco Murillo_English version
Smart ICU project. Dr.Francisco Murillo_English versioneveris/ ehCOS
 
Proyecto Smart ICU. Dr. Francisco Murillo_ Espanol
Proyecto Smart ICU. Dr. Francisco Murillo_ EspanolProyecto Smart ICU. Dr. Francisco Murillo_ Espanol
Proyecto Smart ICU. Dr. Francisco Murillo_ Espanoleveris/ ehCOS
 
The LEAN Initiatives to Transform the A&E in HTAR
The LEAN Initiatives to Transform the A&E in HTARThe LEAN Initiatives to Transform the A&E in HTAR
The LEAN Initiatives to Transform the A&E in HTAREM Doc
 
I AM 2015 guidelines
I AM 2015 guidelinesI AM 2015 guidelines
I AM 2015 guidelinesAIESEC
 
Post Cardiac Arrest by Bernard (SMACC Gold)
Post Cardiac Arrest by Bernard (SMACC Gold)Post Cardiac Arrest by Bernard (SMACC Gold)
Post Cardiac Arrest by Bernard (SMACC Gold)SMACC Conference
 
PHEM - Pre Hospital Emergency Medicine Guidelines for Trainers
PHEM - Pre Hospital Emergency Medicine Guidelines for TrainersPHEM - Pre Hospital Emergency Medicine Guidelines for Trainers
PHEM - Pre Hospital Emergency Medicine Guidelines for TrainersEmergency Live
 
Monitoring Fluid Responsiveness in ICU
Monitoring Fluid Responsiveness in ICUMonitoring Fluid Responsiveness in ICU
Monitoring Fluid Responsiveness in ICUYazan Kherallah
 
Maniobras de Reclutamiento Alveolar - SDRA
Maniobras de Reclutamiento Alveolar - SDRAManiobras de Reclutamiento Alveolar - SDRA
Maniobras de Reclutamiento Alveolar - SDRAJulián Vega Adauy
 
Comparison chart of key changes 2015 aha guidelines for cpr and ecc
Comparison chart of key changes 2015 aha guidelines for cpr and eccComparison chart of key changes 2015 aha guidelines for cpr and ecc
Comparison chart of key changes 2015 aha guidelines for cpr and eccElena Plaza Moreno
 
Anticoagulant and regional anaesthesia
Anticoagulant and regional anaesthesiaAnticoagulant and regional anaesthesia
Anticoagulant and regional anaesthesialogon2kingofkings
 
Introduction to pre hospital care and in
Introduction to pre hospital care and inIntroduction to pre hospital care and in
Introduction to pre hospital care and inIsmail Mohd Saiboon
 

Viewers also liked (20)

AHA Response to 2015 IOM Cardiac Arrest Report
AHA Response to 2015 IOM Cardiac Arrest ReportAHA Response to 2015 IOM Cardiac Arrest Report
AHA Response to 2015 IOM Cardiac Arrest Report
 
CPR2015 update: Adult ACLS
CPR2015 update: Adult ACLSCPR2015 update: Adult ACLS
CPR2015 update: Adult ACLS
 
Pulmonary function tests
Pulmonary function testsPulmonary function tests
Pulmonary function tests
 
Toward real life er
Toward real life erToward real life er
Toward real life er
 
Cpcr 2015 guidelines
Cpcr 2015 guidelinesCpcr 2015 guidelines
Cpcr 2015 guidelines
 
Cpcr
CpcrCpcr
Cpcr
 
Smart ICU project. Dr.Francisco Murillo_English version
Smart ICU project. Dr.Francisco Murillo_English versionSmart ICU project. Dr.Francisco Murillo_English version
Smart ICU project. Dr.Francisco Murillo_English version
 
Proyecto Smart ICU. Dr. Francisco Murillo_ Espanol
Proyecto Smart ICU. Dr. Francisco Murillo_ EspanolProyecto Smart ICU. Dr. Francisco Murillo_ Espanol
Proyecto Smart ICU. Dr. Francisco Murillo_ Espanol
 
The LEAN Initiatives to Transform the A&E in HTAR
The LEAN Initiatives to Transform the A&E in HTARThe LEAN Initiatives to Transform the A&E in HTAR
The LEAN Initiatives to Transform the A&E in HTAR
 
I AM 2015 guidelines
I AM 2015 guidelinesI AM 2015 guidelines
I AM 2015 guidelines
 
Fluid sepsis ny_2013a
Fluid sepsis ny_2013aFluid sepsis ny_2013a
Fluid sepsis ny_2013a
 
Post Cardiac Arrest by Bernard (SMACC Gold)
Post Cardiac Arrest by Bernard (SMACC Gold)Post Cardiac Arrest by Bernard (SMACC Gold)
Post Cardiac Arrest by Bernard (SMACC Gold)
 
PHEM - Pre Hospital Emergency Medicine Guidelines for Trainers
PHEM - Pre Hospital Emergency Medicine Guidelines for TrainersPHEM - Pre Hospital Emergency Medicine Guidelines for Trainers
PHEM - Pre Hospital Emergency Medicine Guidelines for Trainers
 
Monitoring Fluid Responsiveness in ICU
Monitoring Fluid Responsiveness in ICUMonitoring Fluid Responsiveness in ICU
Monitoring Fluid Responsiveness in ICU
 
Maniobras de Reclutamiento Alveolar - SDRA
Maniobras de Reclutamiento Alveolar - SDRAManiobras de Reclutamiento Alveolar - SDRA
Maniobras de Reclutamiento Alveolar - SDRA
 
Cardiopulmonary Resusitation (CPR- AHA 2015)
Cardiopulmonary Resusitation (CPR- AHA 2015)Cardiopulmonary Resusitation (CPR- AHA 2015)
Cardiopulmonary Resusitation (CPR- AHA 2015)
 
Comparison chart of key changes 2015 aha guidelines for cpr and ecc
Comparison chart of key changes 2015 aha guidelines for cpr and eccComparison chart of key changes 2015 aha guidelines for cpr and ecc
Comparison chart of key changes 2015 aha guidelines for cpr and ecc
 
sepsis new guidelines 2017
sepsis new guidelines 2017sepsis new guidelines 2017
sepsis new guidelines 2017
 
Anticoagulant and regional anaesthesia
Anticoagulant and regional anaesthesiaAnticoagulant and regional anaesthesia
Anticoagulant and regional anaesthesia
 
Introduction to pre hospital care and in
Introduction to pre hospital care and inIntroduction to pre hospital care and in
Introduction to pre hospital care and in
 

Similar to Prone cpcr

Similar to Prone cpcr (20)

CPR in prone position
CPR in prone positionCPR in prone position
CPR in prone position
 
Cardiac arrest in special populations - Emerg Med Clin N Am 2011
Cardiac arrest in special populations - Emerg Med Clin N Am 2011Cardiac arrest in special populations - Emerg Med Clin N Am 2011
Cardiac arrest in special populations - Emerg Med Clin N Am 2011
 
Phys ther 1996-ciesla-609-25
Phys ther 1996-ciesla-609-25Phys ther 1996-ciesla-609-25
Phys ther 1996-ciesla-609-25
 
HIGH PERFORMANCE CPR and RESUSCITATION QUALITY IMPROVEMENT
HIGH PERFORMANCE CPR and RESUSCITATION QUALITY IMPROVEMENTHIGH PERFORMANCE CPR and RESUSCITATION QUALITY IMPROVEMENT
HIGH PERFORMANCE CPR and RESUSCITATION QUALITY IMPROVEMENT
 
Cardiac arrest patient management
Cardiac arrest patient  managementCardiac arrest patient  management
Cardiac arrest patient management
 
2010 ECC overview cole v0.2
2010 ECC overview cole v0.22010 ECC overview cole v0.2
2010 ECC overview cole v0.2
 
HP CPR (SHORT)
HP CPR (SHORT)HP CPR (SHORT)
HP CPR (SHORT)
 
Cardiopulmonary resuscitation (cpr)
Cardiopulmonary resuscitation (cpr)Cardiopulmonary resuscitation (cpr)
Cardiopulmonary resuscitation (cpr)
 
Cardio pulmonary resuscitation
Cardio pulmonary resuscitationCardio pulmonary resuscitation
Cardio pulmonary resuscitation
 
A T L S
A T L SA T L S
A T L S
 
Chest physiotheraphy pdf
Chest physiotheraphy pdfChest physiotheraphy pdf
Chest physiotheraphy pdf
 
Intra operative cardiac arrest
Intra operative cardiac arrestIntra operative cardiac arrest
Intra operative cardiac arrest
 
Presentacion
PresentacionPresentacion
Presentacion
 
Atls; Advanced Trauma Life Support
Atls; Advanced Trauma Life SupportAtls; Advanced Trauma Life Support
Atls; Advanced Trauma Life Support
 
Presentacion
PresentacionPresentacion
Presentacion
 
76344.pdf
76344.pdf76344.pdf
76344.pdf
 
VACAR Report 2013:14- Research Highlights
VACAR Report 2013:14- Research HighlightsVACAR Report 2013:14- Research Highlights
VACAR Report 2013:14- Research Highlights
 
Cardio pulmonary resuscitation
Cardio pulmonary resuscitation Cardio pulmonary resuscitation
Cardio pulmonary resuscitation
 
CPR
CPRCPR
CPR
 
Pre Hospital Resuscitation
Pre Hospital ResuscitationPre Hospital Resuscitation
Pre Hospital Resuscitation
 

More from logon2kingofkings

More from logon2kingofkings (9)

Journal club
Journal clubJournal club
Journal club
 
Hm
HmHm
Hm
 
Atc & hm
Atc & hmAtc & hm
Atc & hm
 
Traumatic brain injury
Traumatic brain injuryTraumatic brain injury
Traumatic brain injury
 
Current role of hyperbaric therapy (hbot)
Current role of hyperbaric therapy (hbot)Current role of hyperbaric therapy (hbot)
Current role of hyperbaric therapy (hbot)
 
TRAUMATIC BRAIN INJURY
TRAUMATIC BRAIN INJURYTRAUMATIC BRAIN INJURY
TRAUMATIC BRAIN INJURY
 
Renal replacement therapy
Renal replacement therapyRenal replacement therapy
Renal replacement therapy
 
Acute fatty liver of pregnency
Acute fatty liver of pregnencyAcute fatty liver of pregnency
Acute fatty liver of pregnency
 
Perioperative fluid therapy
Perioperative fluid therapyPerioperative fluid therapy
Perioperative fluid therapy
 

Recently uploaded

Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 

Recently uploaded (20)

Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 

Prone cpcr

  • 1. DR. YOGESH RATHOD DEPARTMENT OF ANAESTHESIOLOGY, SETH GSMC & KEM HOSPITAL, PAREL, MUMBAI.
  • 2. Guidelines and changes of 2015 ACLS When the patient cannot be placed in the supine position, it may be reasonable for rescuers to provide CPR with the patient in the prone position, particularly in hospitalized patients with an advanced airway in place (ClassIIb, LOE C). NOT REVIEWED IN 2015
  • 6. EFFICACY OF CPCR IN PRONE POSITION Efficient CPCR can be performed on a mannequin in the prone position, although additional instructions in technique is required. This may be applicable to patients turned to the prone position. (Critical Care & Resuscitation 2000;2:188-190)
  • 7.  The first case report of successful CPR in the prone position was described by Sun et al. in 1992. Two neurosurgical cases of CPR after acute hypovolemia.  “REVERSE PRECORDIAL COMPRESSION MANEUVER”  One hand placed on the back of the patient, in the mid-thoracic spine & other hand placed on the lower third of the sternum serving as counter-pressure to the compression of the back
  • 9. Brown et al. reported a systematic review of literature and found only 22 cases of CPR in the prone position published from 1966 to 1999, with survival of 10 patients [6]. Since then, few cases have reported prone CPR in database Medline (2000- 2010)
  • 10. •Beltran et al. present two cases of cardiopulmonary arrest and unsuccessful attempts at resuscitation after repositioning supine. •The surgical site of bleeding became inaccessible after repositioning. •Prone resuscitation would have provided a better alternative.
  • 11. •Miranda et al. described a case in which electrical defibrillation was successfully performed in the prone position in a patient undergoing complex spinal surgery. •They suggest that, if defibrillation were required in ventilated patients positioned prone, defibrillation should be attempted in the prone position, as turning the patient supine would consume valuable minutes and reduce the chances of successful defibrillation .
  • 12. •No specific recommendation on the frequency and depth of compressions to the patient in the prone position. •The frequency maintained above 100 cpm and depth sufficient to produce good perfusion indicators but without generating instability between the thoracic and cervical spine, which was fixed by Manfield head-holder. American Heart Association, “2010 American Heart As-sociation Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,” Circulation, Vol. 122, No. 18, 2010, p. 721.
  • 13. “Is the Upside-down Position Better in Cardiopulmonary Resuscitation?” Huey Wen Yien & Wei National Yang Ming University of Medicine & Taipei Veterans General Hospital, Taiwan. (J China Med Assoc, May 2006, vol 69, No 5) P-CPR: 79 ± 20/ 17 ±10 mmHg. M.T.Volume: 300 ± 110 ml. S-CPR: 55 ± 20/ 13 ± 7 mmHg. Conclusions: In some case reports of higher mean blood pressure and intrathoracic pressure, prone CPR may be initiated in a well controlled environment, such as the OR or ICU, to avoid delay in onset of CPR. (Class I, Grade B)
  • 14. Prone CPR is performed frequently in the operating room (OR) on patients • Spine surgeries- deformity corrections • Neurosurgery • other surgical procedures on the back In some situations in the intensive care unit (ICU) •Adult respiratory distress syndrome(ARDS) where all patients are intubated and ventilated PRONE under full-monitoring support.
  • 15. •The first pilot study that documented a higher blood pressure using prone CPR was published by Mazer et al in 2003. •The first systematic review of 16 articles, written by Brown et al in 2001, documented that there were a total of 22 intubated hospitalized patients who received CPR in the prone position, and 10 of them survived to discharge. •Although Stewart emphasized that prone CPR was superior to standard CPR, there is currently no evidence to prove a beneficial outcome.
  • 16. When prone CPR was performed •sternal support with sandbags •gel-filled pads •500-mL bags of IV fluid was suggested.
  • 17. •The thoracic pump model supported prone CPR more than the cardiac pump model. •Increased intrathoracic pressure and systolic blood pressure in 6 cases resuscitated with rhythmic back pressure and sternal counterpressure in the prone position. •A unique mechanism to support this effect is that less anterior displacement of the abdomen during thoracic compressions could enhance the efficiency of CPR effort
  • 18. Hypothetical Benefits and Limitations of Prone CPR Clinical trials of CPR in hospitalized patients or out-of-hospital victims are challenging because interventions must frequently be implemented at a time when informed consent is almost impossible to obtain. Stewart JA. Resuscitating an idea: prone CPR. Resuscitation 2002;53:231–6.
  • 19. Current Evidences and Guidelines of 2005 ACLS The 2005 American Heart Association (AHA) Guidelines for CPR and Emergency Cardiovascular Care (ECC)1 did not endorse the prone position as the standard CPR. It is accepted only as a less-than optimal alternative to supine CPR in certain situations. The recommendation is that “when the patient cannot be placed in the supine position, rescuers may consider providing CPR with the patient in the prone position, particularly in hospitalized patients with an advanced airway in place” (Level of evidence 5; Class IIb) The leader of a resuscitation team should adapt the guidelines to specific circumstances.
  • 20. Prone CPR may be initiated in a well controlled environment, such as the OR or ICU, to avoid delay in onset of CPR. As in bystander CPR for unconscious and unintubated persons, further evidence- based trials of prone CPR should be expected before becoming an alternative practice