A cross-over randomized study on the impact of different recovery positions on blood flow and comfort

13/08/24

International guidelines recommend placing unresponsive individuals with normal breathing, who do not require rescue breathing or chest compressions, in a side-lying recovery position. However, high-certainty evidence regarding the optimal recovery position is lacking. Recent guidelines recommend a position with the lower arm extended rather than bent, hypothesizing that venous drainage in the lower arm might be compromised in case of a bent arm. To generate evidence for this hypothesis, we conducted a randomized controlled trial in collaboration with the Antwerp University Hospital (UZA) to evaluate the effects of two different recovery positions - one with a bent lower arm and one with an extended lower arm - on blood flow and comfort.

The study was a cross-over randomized controlled trial involving eight healthy volunteers who experienced both recovery positions in a random order. Each participant was placed in each recovery position for 15 minutes, with a 15-minute interval in a supine position before and after each recovery position. Various indices of perfusion, or blood flow, in the lower arm were measured. Additionally, participants’ discomfort, pain, and skin discoloration were assessed.

The results showed no significant differences in lower arm perfusion, oxygen saturation, heart rate, subjective pain, and discomfort between the two positions. However, there was slightly more skin discoloration in the extended arm position, contrary to the hypothesis that venous drainage might be compromised in the bent arm position.

The study results allowed us to conclude that both recovery positions are equivalent in terms of perfusion and comfort, filling a gap in evidence and providing support for treatment recommendations regarding recovery positions in first-aid settings. This finding suggests that either position can be used effectively without compromising patient care.

The paper was published in the journal Resuscitation Plus.