Treatment: - To perform a reversed precordial compression, one hand is placed on the patient's back over the mid-thoracic spine and is used to compress the thorax rhythmically. The other hand, which should be clenched into a fist, is placed against the lower third of the sternum and remains there during resuscitation. This serves as a counterforce to the compression of the thorax (1). The sternal counter-pressure device can consist of a sandbag (3).
- A modified technique has been described during spinal surgery with an open wound: compression of the thoracic cage with a palm placed over the scapula on each side of the spinal wound (2).
Contraindications: - For surgery involving the thoracic spine, direct compression from the back is not possible (1).
- For patients who have sternal deformities, this maneuver may not be effective (1).
- In patients who have substantial osteoporosis or bony deformities in whom spinal compression may be deleterious, this technique should be avoided (1).
References: - Wei-Zen Sun et al. Succesful Cardiopulmonary Resuscitation of Two Patients in the Prone Position Using Reversed Precordial Compression. Anesthesiology. 1992;77:202-204: full text.
- Sheron L. Beltran et al. Unsuccessful Resuscitation during Neurosurgery: Is the Supine Position Always Optimal? Anesthesiology. 2008;108:163-164: full text.
- S. P. Mazer et al. Reverse CPR: a pilot study of CPR in the prone position. Resuscitation. 2003;57:279-285: full text | pdf.
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