Prone CPR is an acceptable choice in the setting of COVID-19 where turning a patient supine may create delays or added risk to patient or staff.

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• Matthew J Douma, Ella MacKenzie, Tess Loch, Maria C Tan, Dustin Anderson, Christopher Picard, Lazar Milovanovic, Domhnall O'Dochartaigh, and Peter G Brindley.
• Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada; Alberta Health Services, Canada. Electronic address: douma@ualberta.ca.
• Resuscitation. 2020 Oct 1; 155: 103111103-111.

AimTo identify and summarize the available science on prone resuscitation. To determine the value of undertaking a systematic review on this topic; and to identify knowledge gaps to aid future research, education and guidelines.MethodsThis review was guided by specific methodological framework and reporting items (PRISMA-ScR). We included studies, cases and grey literature regarding prone position and CPR/cardiac arrest. The databases searched were MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Scopus and Google Scholar. Expanded grey literature searching included internet search engine, targeted websites and social media.ResultsOf 453 identified studies, 24 (5%) studies met our inclusion criteria. There were four prone resuscitation-relevant studies examining: blood and tidal volumes generated by prone compressions; prone compression quality metrics on a manikin; and chest computed tomography scans for compression landmarking. Twenty case reports/series described the resuscitation of 25 prone patients. Prone compression quality was assessed by invasive blood pressure monitoring, exhaled carbon dioxide and pulse palpation. Recommended compression location was zero-to-two vertebral segments below the scapulae. Twenty of 25 cases (80%) survived prone resuscitation, although few cases reported long term outcome (neurological status at hospital discharge). Seven cases described full neurological recovery.ConclusionThis scoping review did not identify sufficient evidence to justify a systematic review or modified resuscitation guidelines. It remains reasonable to initiate resuscitation in the prone position if turning the patient supine would lead to delays or risk to providers or patients. Prone resuscitation quality can be judged using end-tidal CO2, and arterial pressure tracing, with patients turned supine if insufficient.Copyright © 2020 Elsevier B.V. All rights reserved.

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