Recovery position significantly associated with a reduced admission rate of children with loss of consciousness

Abstract

Our study demonstrates for the first time that the RP may reduce the admission rate of infants with LOC. Caregivers often perform inadequate manoeuvres when a child becomes unconscious. Campaigns aiming at increasing knowledge of the RP should be promoted.

Highlights from this issue

“…Earlier this year ADC carried a paper titled ‘Recovery position significantly associated with a reduced admission rate of children with loss of consciousness’1 and indeed the side, or ‘recovery' position is standard teaching in basic life support. So it is legitimate to ask whether the traditional practice of managing preterm babies immediately after birth in a supine position is necessarily optimal.…”

Positioning the breathing but unresponsive patient: what is the evidence?

“…Julliand et al 8 report findings from a prospective, observational, multicentre European study of consecutive children seen in 11 paediatric emergency departments (EDs) because of a period of unconsciousness, either at the time of presentation or in the previous 24 h. This is an important study, which was carried out over three months, that evaluated whether primary care givers used the recovery position manoeuvre and whether this intervention was associated with decreased hospital admission rate of these children. There were 557 children in the study, and they represented 5.5% of all paediatric ED consultations.…”

“…The reality, however, is that only observational studies are feasible in emergency, first-responder care, and it is unlikely that an RCT on this intervention will ever be undertaken. In the current report,8 the authors have a number of individuals that were placed in the recovery position, and others that were not. Because it is not clear how patients receiving the intervention differed from those not undergoing placement in the recovery position, it is not possible to examine causation (ie, whether the intervention resulted in better outcomes).…”

“…Because it is not clear how patients receiving the intervention differed from those not undergoing placement in the recovery position, it is not possible to examine causation (ie, whether the intervention resulted in better outcomes). Acknowledging this well-known limitation of observational studies, the key question, then, is what conclusions can be drawn about the first aid recovery position in the unresponsive but breathing patient based on the findings of the study reported by Julliand et al ?8…”

“…Thus, it is unclear whether the associations reported merely reflect another factor and the practice of using the recovery position manoeuvre because of prior experience/education of parents in a population of children with a self-limiting condition that does not usually warrant admission. Since it is unlikely that an RCT on using the recovery position in the breathing but unresponsive patient will be carried out, the new data reported by Julliand et al 8 fill an important gap in our knowledge, in paediatric emergency practice. It not only supports what has been recommended recently,5 6 but also adds to the body of research that remains potentially biased.…”