The efficacy of cardiopulmonary resuscitation in the prone position

Objective: To ascertain whether cardiopulmonary resuscitation (CPR) is effective when performed on a mannequin in the prone position. Methods: Thirty six registered nurses each performed 100 consecutive chest compressions on a Laerdal Resusci-Annie R mannequin immediately after an annual update of CPR technique from an Advanced Life Support (ALS) instructor. Compressions were performed on a mannequin turned to the prone position, on a standard examination couch. A gel-filled pad was placed between the sternum and couch. Nurses were instructed once to perform compressions in the midline, two thirds the way up the torso 'between imaginary scapulae'. Efficacy of compressions was measured using an integral 'skillmeter' in the mannequin. Results: Of 3600 chest compressions performed, 3376 were assessed by the skillmeter. 1168 (34.6%) compressions were 4-5 cm in depth, 1370 (40.6%) were 2-4 cm in depth, and 868 (24.6%) were less than 2 cm. Sixty one per cent of nurses were able to perform adequate CPR at some stage through the cycle. Forty one per cent managed to perform adequate CPR throughout the cycle. Conclusions: Efficient CPR can be performed on a mannequin in the prone position, although additional instruction in technique is required. This may be applicable to patients turned to the prone position. (author abstract)