CPR in prone position during neurosurgery

Abstract

ABSTRACT
Intraoperative cardiac arrest in usual position (prone or lateral) present a unique challenge to the anesthesiologist, where changing to supine position can result in undue delay in initiating CPR or it is not feasible due to skull being fixed and opened by the surgeon.
A 25 kg girl, 6 years old, was undergoing posterior cranial fossa surgery for fourth ventricle tumor excision. She went into hemorrhagic hypovolemic cardiac arrest, despite fluid resuscitation. Immediately, CPR was started in prone position with one hand at the midthoracic spine between the scapulae. The patient had ROSC after 20 min of CPR.
Our patient did not have a favorable outcome, but the resuscitation in the prone position generated sufficient cardiac output while the correction of hypovolemia and hemostasis could be achieved. We recommend that immediate initiation of CPR even in prone position is the best choice in intraoperative patients, where change in position would result in delay in chest compression or make the surgical access impossible.
Key words: Neurosurgery; Cardiac arrest; CPR; Prone position; ROSC; 2015 AHA CPR Guidelines