The impact of different recovery positions on the perfusion of the lower forearm and comfort: A cross-over randomized controlled trial

Background: : 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. Methods: : 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. Results: : 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. Conclusions: : 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.