Effectiveness Of Supine Vs. Prone Position Cardiopulmonary Resuscitation (Cpr): A Mannequin-Based Evaluation

Abstract

Background: Prone positioning has become increasingly common in intensive care settings, particularly for patients with acute respiratory distress syndrome (ARDS) and during the COVID-19 pandemic. However, performing cardiopulmonary resuscitation (CPR) in the prone position remains a challenge due to concerns regarding compression effectiveness. This study evaluates the effectiveness and feasibility of prone CPR compared to supine CPR using a mannequin-based assessment.

Methods: A cross-sectional study was conducted at the Skills Lab, Sri Ramachandra Institute of Higher Education and Research (SRIHER) over three months (March–May 2024). Participants, including trained paramedics and medical professionals, performed two-minute hands-only CPR in both supine and prone positions on a Laerdal QCPR mannequin. Data on compression rate, depth, recoil, and overall CPR quality (Q-CPR Score) were collected using a mobile application linked to the mannequin. Statistical analysis was conducted using SPSS version 2.0.

Results: Supine CPR demonstrated a higher total Q-CPR score (92.9 vs. 85.3, p = 0.020) and better compression depth consistency (85.5% achieving optimal depth vs. 50.7% in prone CPR, p < 0.001). However, prone CPR exhibited significantly superior recoil performance (82.6% vs. 65.2%, p = 0.017), suggesting better chest compression and venous return. Compression rate was comparable between both positions (p = 0.234), indicating that effective compression frequency could be maintained regardless of patient positioning.

Conclusion: While supine CPR remains the gold standard, prone CPR is a viable alternative in cases where repositioning a patient is not feasible, particularly in ICUs and surgical settings. The higher recoil performance in prone CPR suggests its potential to support effective circulation, though variability in compression depth highlights the need for further training and technique refinement. Standardized protocols, optimized hand placement techniques, and additional research are necessary to improve prone CPR effectiveness and integration into advanced life support (ALS) guidelines.