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E Poster discussion: Circulation

Abstract PR030: Cardiac Arrest in Prone Position; When Do I Make Patient Supine?

Kaur, J.1,*; Kane, D.1; Shinde, S.1; Dongre, V.1

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doi: 10.1213/01.ane.0000492440.41192.e3
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Case Report: Cardiac arrest in prone position is encountered in patients undergoing spine and neurosurgery. Cardio Pulmonary resuscitation (CPR) in prone position presents additional challenge to anaesthesiologist primarily because of limited knowledge and lack of sufficient evidence to support the efficacy. Since, early cardiopulmonary resuscitation (CPR) and rapid defibrillation is the backbone of basic life support algorithms, changing position can delay onset of compressions and lead to detrimental consequences. Although the supine position is optimal for CPR, it may not be feasible in case of active bleeding site and can damage craniospinal structures.

Rudikoff et al postulated the thoracic pump mechanism according to which external chest compressions increase intra thoracic pressure which forces blood to flow from thoracic to systemic circulation with heart acting as a passive conduit.[1] Human studies on efficacy of CPCR in prone position suggest that higher systolic and mean blood pressures (BP) are generated in prone as compared to supine position. [2]

We report successful management of cardiac arrest in prone position in two patients undergoing spine surgery.

Case 1: A 14 year old, male patient, ASA I underwent thoracic spine deformity correction surgery for Koch’s spine. After induction of anaesthesia, he was placed in prone position. During the surgical procedure, the patient developed severe bradycardia followed by asystole possibly due to parasympathetic stimulation. CPR was started in prone position with sternal support and return of spontaneous circulation (ROSC) was achieved in four minutes. However post operatively, the patient arrested again after 12 hours and couldn’t be revived.

Case 2: A 25 year old female, ASA I, 40 kg thin built patient was posted for lumbar spine surgery. Intra operatively there was minimal blood loss. However, there was sudden exsanguination of 1.5l of blood in suction with possible entry of drain tube into epidural venous plexus leading to abrupt hypotension and arrest just before turning to supine position. She was immediately made supine, resuscitation started, colloids and crystalloids infused till availbility of blood and ROSC achieved in three minutes.

Conclusion: We concluded that immediate beginning of resuscitation either in supine or prone position could generate sufficient cardiac output when the cause of cardiac arrest is addressed simultaneously.

References:

1. Rudikoff MT, Maughan WL, Effron M, Freund P, Weisfeldt ML. Mechanisms of blood flow during cardiopulmonary resuscitation. Circulation 1980;61:345–52.

2. Mazer SP, Weisfeldt M, Bai D, Cardinale C, Arora R, Ma C, et al. Reverse CPR: A pilot study of CPR in the prone position. Resuscitation 2003;57:279–85.

Disclosure of Interest: None declared

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