Influence of different types of recovery positions on perfusion indices of the forearm.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
The results of this study suggest that AHA position causes less circulatory disturbances than the ERC, MMC and Rautek's positions.
Rathgeber
J
J
Department of Anaesthesiology, Emergency and Intensive Care Medicine, Georg-August-Universität Göttingen, Germany.
Panzer
W
W
Günther
U
U
Scholz
M
M
Hoeft
A
A
Bahr
J
J
Kettler
D
D
D000328:Adult; D016887:Cardiopulmonary Resuscitation; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D010477:Perfusion; D011187:Posture; D016684:Prone Position; D012016:Reference Values; D012039:Regional Blood Flow / Q000502:physiology; D016683:Supine Position