Rathgeber J, Panzer W, Günther U, Scholz M, Hoeft A, Bahr J, Kettler D
Department of Anaesthesiology, Emergency and Intensive Care Medicine, Georg-August-Universität Göttingen, Germany.
Resuscitation. 1996 Jul;32(1):13-7. doi: 10.1016/0300-9572(96)00952-5.
Basic life support guidelines of the European Resuscitation Council (ERC) suggest a modified type of recovery position compared to that recommended by the American Heart Association (AHA). However, anecdotal reports and the results of a small study by Fulstow and Smith (Resuscitation 1993; 26: 89-91) gave evidence that the new ERC position may cause an impairment of perfusion of the lower forearm. The aim of our study was to evaluate the effects of different recovery positions on arterial perfusion and venous drainage of the forearm.
We placed 20 young healthy volunteers randomly in either ERC or AHA position for 15 min first, and in the other position thereafter. Before and between volunteers were positioned supine. In a second series 10 volunteers were positioned according to the same protocol in semiprone positions as described by Morrison, Mirkhur and Craig (MMC), and Rautek's position, respectively. Forearm perfusion indices of the dependent arm were continuously assessed by photoplethysmographic pulsatility change, photoplethysmographic volume change, invasive peripheral venous pressure and non-invasive blood pressure amplitude. Subjective discomfort was assessed non-qualitatively.
All indices of arterial perfusion demonstrated an impairment of arterial inflow in ERC, MMC and Rautek's position as well as venous congestion in these three positions. On the contrary, AHA position was associated with no significant changes of arterial flow and only moderate, insignificant signs of venous congestion.
The results of this study suggest that AHA position causes less circulatory disturbances than the ERC, MMC and Rautek's positions.
欧洲复苏委员会（ERC）的基本生命支持指南建议采用一种与美国心脏协会（AHA）推荐的复苏体位不同的改良型复苏体位。然而，一些轶事报道以及富尔斯托和史密斯的一项小型研究结果（《复苏》，1993年；26: 89 - 91）表明，新的ERC体位可能会导致前臂下部灌注受损。我们研究的目的是评估不同复苏体位对前臂动脉灌注和静脉回流的影响。
我们首先将20名年轻健康志愿者随机置于ERC体位或AHA体位15分钟，然后再置于另一种体位。在志愿者体位改变之前和之间，他们均处于仰卧位。在第二个系列中，10名志愿者按照相同方案分别置于莫里森、米尔胡尔和克雷格（MMC）描述的半俯卧位以及劳特克体位。通过光电容积脉搏波描记法的搏动性变化、光电容积脉搏波描记法的容积变化、有创外周静脉压和无创血压幅度持续评估受影响手臂的前臂灌注指标。对主观不适进行非定性评估。
动脉灌注的所有指标均显示，在ERC体位、MMC体位和劳特克体位下存在动脉流入受损以及这三种体位下的静脉充血情况。相反，AHA体位与动脉血流无显著变化以及仅出现中度、不显著的静脉充血迹象相关。
本研究结果表明，AHA体位比ERC体位、MMC体位和劳特克体位引起的循环障碍更少。
