What is the best position to place and re-evaluate an unconscious but normally breathing victim? A randomised controlled human simulation trial on children. (January 2019)

• Record Type: Journal Article
• Authors: Navarro-Patón, Rubén; Freire-Tellado, Miguel; Fernández-González, Noel; Basanta-Camiño, Silvia; Mateos-Lorenzo, Javier; Lago-Ballesteros, Joaquín
• Is Part Of: Resuscitation. Volume 134(2019)
• Page Start: 104
• Page End: 109
• Publication Date: 2019-01
• Subjects: CPR cardiopulmonary resuscitation -- OHCA out-of-hospital cardiac arrest -- BLS basic life support -- HTCL head tilt and chin lift technique -- RP recovery position -- HTCL group head tilt and chin lift group -- RP regularly recovery position, checking the victim regularly group -- RP minute recovery position, breathing re-evaluation every minute group -- EMS emergency medical services -- ERC European resuscitation guidelines; Recovery position -- CPR -- Breathing assessment -- Out-of-hospital cardiac arrest -- Head-tilt and chin-lift -- Schoolchildren; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2018.10.030
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Background: Current resuscitation guidelines endorse placing the unconscious and normally breathing victims in the recovery position (RP), but this technique might hinder breathing evaluation. Aim: To compare breathing evaluation and cardiac arrest detection: placing the victim in RP and checking breathing regularly, placing the victim in RP while re-evaluating breathing every minute, and placing the victim on his back, maintaining an open airway with the head-tilt-chin-lift technique and continuously checking breathing. Methods: Schoolchildren aged 10–12 with no previous cardiopulmonary resuscitation (CPR) training, from three different primary schools were randomly allocated into groups to receive a CPR course involving one of the three strategies. Then a human simulation took place. Result: 192 schoolchildren (64 per group) were randomly selected and received one of the courses. 182 participants who correctly assessed the victim were compared: 16 (26.2%) out of the 59 participants using RP and checking breathing regularly detected cardiac arrest before the end of the simulation, compared to 41 (67.20%) out of 61 using RP re-evaluating breathing every minute, and 56 (90.3%) out of 62 using head-tilt-chin-lift. Statistically significant differences were found between the RP groups (p < 0.001; OR = 5.766) as well as between the Head-tilt-chin-lift and both RP groups (p < 0.001; OR = 21.094), (p = 0.002; OR = 4.553). Conclusion: The strategy involving head-tilt-chin-lift significantly increased the likelihood of detecting cardiac arrest. Re-evaluating every minute when the RP was used significantly increased the likelihood of detecting cardiac arrest.