Intraoperative cardiopulmonary resuscitation in the prone position

Cardiopulmonary resuscitation (CPR) occasionally is necessary in the operating-room setting. In such instances, it may be difficult to perform CPR if the patient is in the prone position. Although the supine position is optimal for CPR, it may not be feasible because of the risks of damage to craniospinal structures. The authors present the case of a 12-year-old boy who had cardiac arrest during spinal fusion. Successful CPR was performed with the patient in the prone position, with the use of "reversed precordial compressions," and the patient was resuscitated despite 7 minutes of asystole. Effective cardiac output was maintained and was confirmed by systolic blood pressure readings of 80 to 90 mm Hg on both the arterial catheter waveform and the noninvasive blood pressure cuff, by a waveform and the reading on the pulse oximeter, and by the presence of end-tidal carbon dioxide.