Cardiopulmonary Resuscitation (Cpr) in Prone Position in the Operating Room: Clinical Applications and the Role of the Nurse

Abstract

Cardiac arrest during surgical interventions in the operating room requires a rapid and effective intervention. İn standard cardiopulmonary resuscitation (CPR) applications, the patient is usually evaluated in the supine position, whereas during spinal surgeries, some neurosurgical and thoracic interventions, patients are in the prone position, which creates difficulties in resuscitation applications. Since turning a patient in the prone position to the supine position may cause loss of time, resuscitation in the prone position may be necessary as an alternative CPR method. When performing CPR in the prone position, chest compressions are performed on the posterior surface of the thorax. These compressions, usually focused at the T7-T10 vertebral level, are critical to improve cardiac output and circulation.  Compressions should be performed at a rate of 100-120 per minute and at sufficient depth. However, factors such as surgical position, support equipment used and the patient's condition may affect the effectiveness of CPR. Therefore, proper positioning and compression techniques should be determined in accordance with the patient's condition and surgical procedure. İn terms of airway management, rapid intubation or use of a supraglottic airway device (e.g. laryngeal mask) should be preferred if the patient is not intubated. İf the patient is positioned with face pillows, ventilation can be provided by turning the head to the side or with a mask. The tube should be fixed and ventilation parameters should be carefully monitored to prevent displacement of the endotracheal tube. İf manual ventilation is applied, appropriate mask selection should be made to minimize air leakage. İn patients in need of defibrillation, electrode pads can be placed either in the anteroposterior position or in the bilateral scapula region to deliver energy. Correct electrode placement may improve the efficacy of defibrillation. Various case series and experimental studies in the literature show that CPR in the prone position can provide adequate cardiac output. İt is of great importance that the operating room team is trained in this regard, patients are managed in the prone position according to resuscitation algorithms and early intervention is provided. Having predetermined resuscitation plans for emergencies that may develop in the prone position during surgery enables healthcare professionals to intervene quickly and effectively. Nurses play a critical role in optimizing patient positioning, providing airway management and ensuring continuity of ventilation. İt is also necessary to ensure regular trainings to improve response success in such critical situations. İt is important for nurses and the surgical team to be familiar with the subject to ensure patient safety and increase efficiency in the resuscitation process. İn conclusion, CPR in the prone position in the operating room setting is an important resuscitation method for patients with cardiac arrest. However, further clinical research and development of updated protocols are necessary to improve the efficacy of this practice. İt is critical for nurses to be trained in this area to ensure patient safety and to successfully manage the intervention process.