De Buck Emmy, Scheers Hans, Vandekerckhove Philippe, Vermeulen Dorien, Heidbuchel Hein, Heuten Hilde
Centre for Evidence-Based Practice, Belgian Red Cross, Motstraat 40, 2800 Mechelen, Belgium.
Cochrane First Aid, Motstraat 40, 2800 Mechelen, Belgium.
Resusc Plus. 2024 Jul 19;19:100722. doi: 10.1016/j.resplu.2024.100722. eCollection 2024 Sep.
International guidelines recommend a side-lying recovery position for unresponsive individuals with normal breathing who do not require cardiopulmonary resuscitation. However, high-certainty evidence about an optimal recovery position is lacking. Recent guidelines recommend a position with the arm extended rather than bent, hypothesizing that venous drainage in the dependent lower arm might be compromised. This cross-over randomized controlled trial aims to evaluate the effect of recovery positions with bent or extended arm on perfusion of the lower forearm and comfort.
Eight healthy volunteers were placed in each of the recovery positions for 15 min, in random order, with an interval of 15 min in supine position. Various perfusion indices of the dependent arm were assessed by radial artery tonometry, ulnar artery echo doppler, and venous congestion plethysmography, as well as participant discomfort, pain and skin discoloration. Differences in outcomes were analyzed with linear mixed models.
Our study found no statistically significant difference in systolic peripheral arterial pressure in the radial artery, peripheral venous pressure at the back of the hand, oxygen saturation, heart rate, subjective pain and discomfort, when comparing both postures. Participants slightly experienced more skin discoloration in the position with extended arm.
We conclude that, since perfusion of the dependent arm was shown to be similar in both positions, both recovery positions can be used. These conclusions fill a gap in evidence and can further support the treatment recommendations regarding the recovery position in first aid settings.
国际指南推荐对于呼吸正常、无需心肺复苏的无反应个体采用侧卧位恢复体位。然而，缺乏关于最佳恢复体位的高确定性证据。近期指南推荐手臂伸展而非弯曲的体位，推测下垂的下臂静脉回流可能会受到影响。这项交叉随机对照试验旨在评估手臂弯曲或伸展的恢复体位对前臂灌注和舒适度的影响。
8名健康志愿者依次被置于每种恢复体位15分钟，仰卧位间隔15分钟。通过桡动脉张力测量法、尺动脉超声多普勒和静脉充血体积描记法评估下垂手臂的各种灌注指标，以及参与者的不适、疼痛和皮肤变色情况。使用线性混合模型分析结果差异。
比较两种体位时，我们的研究发现桡动脉收缩期外周动脉压、手背外周静脉压、血氧饱和度、心率、主观疼痛和不适方面均无统计学显著差异。参与者在手臂伸展的体位中皮肤变色略多。
我们得出结论，由于两种体位下下垂手臂的灌注相似，两种恢复体位均可使用。这些结论填补了证据空白，可进一步支持急救环境中关于恢复体位的治疗建议。
