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'Reverse CPR' performed on back could better restore blood flow

A pilot study of the first proposed major change in decades to cardiopulmonary resuscitation (CPR) suggests that performing the maneuver while patients are on their stomachs offers far better restoration of blood flow and blood pressure than the standard practice of keeping patients on their backs. The feasibility study of so-called reverse CPR, conducted by researchers at Johns Hopkins and Columbia universities, appears in the June issue of the journal Resuscitation.

CPR in the prone position was tested at Columbia Presbyterian Medical Center on six critically ill patients already in intensive care units whose hearts had stopped, and who had failed to respond to standard CPR for at least a half-hour.

Toward the end of this period, an additional 15 minutes of standard CPR was performed with blood pressure monitoring. Then, turning the patients over and adding reverse CPR for 15 minutes, doctors were able to increase average systolic blood pressure (the upper number in blood pressure measures) from 48 mmHg to 72 mmHg. The new approach also improved average arterial blood flow pressure from 32 mmHg to 46 mmHg. Although none of the patients survived, the researchers say the results demonstrate a compelling need for further investigation of reverse CPR's likely benefits to many patients.

"This is not a mandate to change current CPR practice, but it does raise interesting possibilities for continuing research," says Myron L. Weisfeldt, M.D., a cardiologist, co-author of the study and chairman of the Department of Medicine at Johns Hopkins, who participated in the research while chairman of medicine at Columbia. "It's widely recognized that while CPR is important in saving lives from cardiac arrest, the amount of blood flow provided is very low."

Although mouth-to-mouth ventilation is a key feature of bystander CPR -- that performed outside the hospital setting -- it is frequently not performed at all or done poorly. There is
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Contact: Karen Blum
kblum@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
23-Jun-2003


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