Case reportCardiac arrest during surgery and ventilation in the prone position: a case report and systematic review
Introduction
The prone position allows access for surgery [1], [2]. In the intensive care unit, patients with acute respiratory distress syndrome (ARDS) are increasingly being ventilated in the prone position [3], [4]. Cardiac arrest in these patients is difficult to manage as poor access makes cardiopulmonary resuscitation (CPR) and defibrillation difficult. These difficulties can be further exacerbated in the surgical patient with an open wound, protruding surgical metal work and an unstable spine. There are few case reports of such arrests and few guidelines as to how to manage them. Current methods of CPR are geared towards supine patients. We describe a case report of cardiac arrest due to ventricular fibrillation during surgery in the prone position. We discuss risk factors and suitable techniques for the management of patients with cardiac arrest whilst ventilated in the prone position.
Section snippets
Case report
A 60-year-old female patient (weight 67 kg), underwent thoracic spine decompression surgery for an invasive tumour between the T-11 and L-1 vertebral levels. The patient had no other past medical history of note and no abnormalities in pre-operative investigations.
Anaesthesia was induced with intravenous propofol, fentanyl and rocuronium. The patient was ventilated with oxygen, nitrous oxide and isoflurane via a reinforced 8 mm tracheal tube. Invasive arterial and central venous pressures were
Methods
We conducted a literature search using the medline database between 1966 and December 1999 for all publications in any language. The MeSH search headings ‘prone’, ‘spinal’, ‘resuscitation’, ‘cardiac’ and ‘arrest’ were used. Abstracts were used to identify relevant articles. The reference lists of all the identified articles were also used to capture any articles not identified by the medline search.
Results
We identified 16 suitable articles [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15],
Review of literature
Cardiac arrest during surgery in the prone position is rare judging from the scarcity of case reports. The majority of cases describe successful outcomes. Publication bias towards good outcome may underestimate the frequency of prone cardiac arrest. Interestingly most of the survivors are in the more recently published case reports (Table 1). Publication bias will also have had an influence on what is published as more extreme cases are likely to be published [23].
Conclusions
Cardiac arrest in patients undergoing surgery in the prone position is rare. Pre-operative risk factors include pre-existing cardiac disease. Intra-operative factors include haemorrhage, gas embolism and diminished venous return to the heart. Management of prone cardiac arrest may be improved by identification of high-risk patients, careful patient positioning, use of invasive monitoring and placement of self-adhesive defibrillator paddles. Successful methods for cardiac compressions and
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Cardiopulmonary resuscitation in prone position: A scoping review
2020, American Journal of Emergency MedicineCitation Excerpt :We found no RCT comparing prone to standard supine CPR. Three of the included studies [9-11] had a nonrandomized design and 31 were case reports [12-42]. In this section, the included nonrandomized studies are described; a complete description of all the studies, including case reports, is provided with details in Table 1.