title: Reverse CPR: a pilot study of CPR in the prone position.
abstract: BACKGROUND
  Cardiopulmonary resuscitation (CPR), as described in 1960, remains the cornerstone of therapy for cardiopulmonary arrest. Recent case reports have described CPR in the prone position. We hypothesized rhythmic back pressure on a patient in the prone position with sternal counter-pressure (termed reverse CPR here) would increase intra-thoracic pressure and in turn systolic blood pressure (SBP) during cardiac arrest versus standard CPR.
  
  
  RESULTS
  Six patients from Columbia Presbyterian Medical Center's Cardiac and Medical Intensive Care Units (CICU and MICU) were enrolled. Eligible patients had suffered circulatory arrest and failed standard CPR for at least 30 min. After enrollment the patients received 15 additional min of standard CPR and then reverse CPR for 15 min. The study's primary endpoint, mean SBP, significantly improved from 48 mmHg during standard CPR to 72 mmHg during reverse CPR (mean improvement=23+/-14 mmHg). Mean calculated mean arterial pressure (MAP) was also improved significantly from 32 mmHg during standard CPR to 46 mmHg during reverse CPR (mean improvement=14+/-11 mmHg). The mean diastolic blood pressure (DBP) improved from 24 mmHg during standard to 34 mmHg during reverse CPR (mean improvement=10+/-12 mmHg). This difference did not meet statistical significance. No patients had return of spontaneous circulation.
  
  
  CONCLUSIONS
  Reverse CPR generates higher mean SBP and higher mean MAP during circulatory arrest than standard CPR. These novel findings justify further research into this technique.
authors.affiliation: Division of Cardiology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, New York, NY 10032, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Mazer
authors.forename: Myron
authors.initials: M
authors.lastname: Weisfeldt
authors.forename: Diane
authors.initials: D
authors.lastname: Bai
authors.forename: Carol
authors.initials: C
authors.lastname: Cardinale
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ma
authors.forename: Robert R
authors.initials: RR
authors.lastname: Sciacca
authors.forename: David
authors.initials: D
authors.lastname: Chong
authors.forename: LeRoy E
authors.initials: LE
authors.lastname: Rabbani
mesh_terms: D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011336:Probability; D016684:Prone Position; D011659:Pulmonary Gas Exchange; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D013990:Tidal Volume; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000628:therapy*