Is the upside-down position better in cardiopulmonary resuscitation?

Over the past 2 decades, a variety of alternatives to standard cardiopulmonary resuscitation (CPR), such as interposed abdominal compression (IAC)-CPR and cough CPR, and use of devices such as the circumferential vest, have been developed in an effort to enhance ventilation or perfusion during cardiac arrest, and eventually to improve the outcome of survival. Compared with standard CPR, these techniques and devices typically require additional personnel, training, or equipment for specific settings. However, with the exception of early defibrillation, most could not be reproduced consistently, and the results were also disappointing. Standard supine CPR has a less than 5% overall survival rate in out-of-hospital cardiac arrest. Practitioners are often reluctant to perform CPR for fear of infectious transmission from mouth-tomouth ventilation, as well as aspiration of gastric regurgitant.