The Impact of Different Recovery Positions on the Perfusion of the Lower Forearm and Comfort
Condition: Unconsciousness
MeSH terms: Unconsciousness
Study type: Interventional

Summary: 
      Introduction: A side-lying recovery position is recommended when victims are unresponsive but
      breathing normally and, hence, do not require cardiopulmonary resuscitation. In 2021, the
      European Resuscitation Council (ERC) and the Belgian Red Cross-Flanders issued new guidelines
      which included the description of a modified recovery position to avoid problems in victims
      with joint stiffness and to overcome potential obstructed venous return in the dependent arm.
      Based on good practice insights, the dependent arm will now be extended and not bent to
      support the other arm. However, there is currently no evidence available to support a
      specific recovery position.

      Objectives: The aim of this study is to assess the impact of different recovery positions on
      perfusion of the forearm and associated comfort.

      Methods: In this cross-over randomized controlled trial, 24 healthy volunteers will be placed
      in either the lateral recovery position with extended dependent arm or with bent arm, and in
      the other position thereafter. Before and between both recovery positions, the volunteers
      will be positioned supine for 15 min. Several perfusion indices of the forearm will be non-or
      mildly invasively monitored in the respective recovery positions by radial artery tonometry,
      ulnar artery echo doppler and venous congestion plethysmography. Subjective participant's
      discomfort and pain will be assessed as well. Differences in continuous outcomes between the
      different recovery positions will be assessed with paired t-tests or wilcoxon signed-rank
      test.

      Discussion: The benefit of lateral positioning of adults and children with decreased level of
      consciousness has been widely accepted despite limited supportive scientific evidence. We
      here will provide direct evidence (i) whether venous drainage in the dependent limb is
      impaired when positioning the victim in the lateral recovery position with bent arms and (ii)
      whether this potential complication can be minimized by extending the dependent arm. The
      major limitations of this study is that healthy volunteers, instead of non-responsive
      victims, are included as participants, and that the study will be performed in a highly
      controlled environment. Nevertheless, the generated insights will directly fuel
      evidence-based treatment recommendations regarding the recovery position in first aid
      settings, and fill a current gap in evidence.
    


Intervention name(s): recovery position
Intervention type(s): Other
Intervention description(s): A side-lying recovery position is a first aid intervention that can be performed by laypeople when victims are unresponsive but breathing normally and, hence, do not require cardiopulmonary resuscitation.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: This study is a cross-over Randomized Controlled Trial in which the sequence of the lateral recovery position will be randomized.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Recovery position; First aid for unconsciousness; Arterial flow