Abstract
Background: The COVID-19 pandemic highlights the challenges associated with managing cardiac arrest in patients positioned in the prone position due to refractory respiratory failure (Guérin et al., 2013; Ludwin et al., 2020). Studies suggest that clinical staff often lack confidence in delivering effective prone resuscitation (Amien et al., 2022; Genç et al., 2023), indicating a need to review literatures on the efficacy, feasibility, and the proper technique for performing prone cardiopulmonary resuscitation (CPR).
Aim: This project aimed to identify the effective approach for performing prone resuscitation and to translate the best available evidence into a prone CPR protocol.
Methods: The study employed the Johns Hopkins Model as the conceptual framework (Dang et al., 2022). A systematic literature review was conducted to compare the performance of prone CPR versus supine CPR for patients requiring prone ventilation. Major databases and grey literature sources were searched, and original research, case reports, manikin studies, and clinical guidelines were included. Data was synthesized and critically appraised by two independent authors.
A protocol was developed based on the synthesis. Comprehensive training on the prone CPR will be provided to clinical staff to improve preparedness and competence.
Results: The search identified 311 articles via 6 databases, with 45 full-text articles reviewed in depth. The majority were lower-level case reports (n=32), and 8 were practice guidelines.
Five original studies evaluated the effectiveness of prone CPR in terms of physiological measures. The existing evidence suggests that prone CPR may offer a viable alternative, potentially improving hemodynamic parameters. However, the lack of high-quality trials limits the ability to draw conclusions, and confounding factors related to patient heterogeneity could not be adequately addressed.
A prone CPR protocol was developed based on the synthesized evidence, outlining optimal hand placement and compression techniques. Comprehensive training on this protocol is currently underway, with pre- and post-training assessments to evaluate changes in relevant skills and knowledge.
Conclusion: The findings indicate that prone CPR may serve as an alternative when immediate supination becomes impossible. Further high-quality research is needed to establish definitive guidelines. The effectiveness on enhanced nurses' competency on prone CPR will become evident followed by subsequent evaluation.
Notes
CPR in the prone position is an imminent issue in critical care, particularly relevant when patients cannot be safely supinated. Research suggests that prone CPR is considered as a feasible alternative. Integrating evidence-based practices and comprehensive training of clinical staff are crucial for improving patient outcomes during cardiac arrests. This project is a step forward in improving critical care and could have implications for future guidelines and training development.
Sigma Membership
Pi Iota at-Large
Type
Poster
Format Type
Text-based Document
Study Design/Type
Systematic Review
Research Approach
Other
Keywords:
Acute Care, Transition to Practice or Onboarding, CPR Methods, Prone CPR, Cardiopulmonary Resuscitation
Recommended Citation
Lai, Ka Wing; Wan, Tsz Kee; Lam, Yiu Ming; Li, Shuk In; and Lai, Sharon, "Development of a Prone CPR Protocol" (2025). International Nursing Research Congress (INRC). 160.
https://www.sigmarepository.org/inrc/2025/posters_2025/160
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Development of a Prone CPR Protocol
Seattle, Washington, USA
Background: The COVID-19 pandemic highlights the challenges associated with managing cardiac arrest in patients positioned in the prone position due to refractory respiratory failure (Guérin et al., 2013; Ludwin et al., 2020). Studies suggest that clinical staff often lack confidence in delivering effective prone resuscitation (Amien et al., 2022; Genç et al., 2023), indicating a need to review literatures on the efficacy, feasibility, and the proper technique for performing prone cardiopulmonary resuscitation (CPR).
Aim: This project aimed to identify the effective approach for performing prone resuscitation and to translate the best available evidence into a prone CPR protocol.
Methods: The study employed the Johns Hopkins Model as the conceptual framework (Dang et al., 2022). A systematic literature review was conducted to compare the performance of prone CPR versus supine CPR for patients requiring prone ventilation. Major databases and grey literature sources were searched, and original research, case reports, manikin studies, and clinical guidelines were included. Data was synthesized and critically appraised by two independent authors.
A protocol was developed based on the synthesis. Comprehensive training on the prone CPR will be provided to clinical staff to improve preparedness and competence.
Results: The search identified 311 articles via 6 databases, with 45 full-text articles reviewed in depth. The majority were lower-level case reports (n=32), and 8 were practice guidelines.
Five original studies evaluated the effectiveness of prone CPR in terms of physiological measures. The existing evidence suggests that prone CPR may offer a viable alternative, potentially improving hemodynamic parameters. However, the lack of high-quality trials limits the ability to draw conclusions, and confounding factors related to patient heterogeneity could not be adequately addressed.
A prone CPR protocol was developed based on the synthesized evidence, outlining optimal hand placement and compression techniques. Comprehensive training on this protocol is currently underway, with pre- and post-training assessments to evaluate changes in relevant skills and knowledge.
Conclusion: The findings indicate that prone CPR may serve as an alternative when immediate supination becomes impossible. Further high-quality research is needed to establish definitive guidelines. The effectiveness on enhanced nurses' competency on prone CPR will become evident followed by subsequent evaluation.
Description
References:
Amien, N., Bresick, G., & Evans, K. (2022). Preparedness for paediatric cardiopulmonary resuscitation amongst medical doctors working in primary health care facilities in Cape Town, South Africa. South African Family Practice, 64(1), 5323.
Dang, D., Dearholt, S. L., Bissett, L., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model and Guidelines (Fourth edition.). Sigma Global Nursing Excellence.
Genç, M., Günaydin, G. P., & Yildirim, Ç. (2023). Knowledge and Practice of Prone Cardiopulmonary Resuscitation Among Physicians: A Survey Study. Anatolian Journal of Emergency Medicine, 6(2), 66-71.
Guérin, C., Reignier, J., Richard, J. C., Beuret, P., Gacouin, A., Boulain, T., ... & Ayzac, L. (2013). Prone positioning in severe acute respiratory distress syndrome. New England Journal of Medicine, 368(23), 2159-2168.
Ludwin, K., Szarpak, L., Ruetzler, K., Smereka, J., Böttiger, B. W., Jaguszewski, M., & Filipiak, K. J. (2020). Cardiopulmonary Resuscitation in the prone position: a good option for patients with COVID-19. Anesthesia and Analgesia, 131(3), e172–e173.