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

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.

Keywords: Breathing assessment; CPR; Head-tilt and chin-lift; Out-of-hospital cardiac arrest; Recovery position; Schoolchildren.