05/17/2020
We are all still learning about COVID. Prone CPR is a method of use that is not widely taught, but it is recognized. I anticipate this will be put into the ACLS curriculum in the future. This method would only be for advanced hospital providers with intubated COVID patients.
Here is the info that I have:
Hand Positioning for Prone CPR (Resuscitation in Prone Position)
Method #1 ~
Direct Spine Compression
Direct Hands Position over the Posterior Thoracic Spine, similar to Supine CPR on the Sternum. Based on AHA Guidelines, CPR hand positioning is on the T7-T10 Area. Meanwhile, ERC Guidelines state that CPR hand positioning is on the thoracic spine between the scapula or shoulder blades, just behind the heart. Counter Pressure is OPTIONAL, as long as the Posterior Chest Wall is rhythmically compressed towards the Anterior Chest Wall. But the sternum must touch the hard surface, so that the pressure can be exerted on the cardiac muscle INDIRECTLY.
This method must only be used on the patient who has a Healthy Spine. If rhythmic pressure is being applied, the thoracic spine CANNOT Be Easily Broken due to its stiffness as the rigid costovertebral joints hold the vertebra. As intervertebral discs only allow Slight Movement of the vertebra, Prone CPR cannot lead to spinal injury during compressions, UNLESS if the patient has osteoporosis or any other spinal condition due to the impact from fall or any vehicular accidents.
Method #2 ~
Interscapular Compression
Direct Hands Position over both Scapula / Shoulder Blades or just over the side of the thoracic spine. Counter Pressure is OPTIONAL, as long as the Posterior Chest Wall is rhythmically compressed towards the Anterior Chest Wall. But the sternum must touch the hard surface, so that the pressure can be exerted on the cardiac muscle INDIRECTLY.
This method is suitable for patient who has spinal condition in which direct spine compressions cannot be applied. Also if the rescuers are not comfortable with direct spine pressure or are afraid that compressing the spine might lead to fractures and injuries, they can rhythmically compress both the scapula towards the anterior chest wall. This resuscitation method can also be used during Spinal Surgery when the cardiac arrest patient has an open surgical wound from the back.
Method #3 ~
Reversed Precordial Compression
This technique can be done with a single rescuer. One hand position over the patient’s back, whether on the spine or the scapula, while the other hand is under the patient’s sternum acting as counter pressure. If there is another rescuer, one person commence Posterior Chest Compression and the other one positions the hands or clenched fist under the patient’s chest as counter pressure.
When using this resuscitation method, be careful if the patient has both spinal and sternal injuries.
