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

First aid for the unconscious but still breathing infant or child who has no other life-threatening condition is something everyone needs to know. Providing spinal injury is not suspected, first aid care involves placing the subject in the recovery position so that the airway remains clear and open.1 Videos that explain and show how to position such an infant or a child can be found on a number of professional websites, including National Health Service Choices,1 British Red Cross,2 St. John Ambulance3 and the Epilepsy Society.4

A good quality clinical practice guideline (CPG) is based on a process that includes defining a clear PICO (Patient, Intervention, Comparison, Outcome) question, seeking the highest quality evidence available, appraising and synthesising this evidence, then creating a recommendation by assimilating this information with the clinical/patient expertise of the CPG developers. Recently, the use of the lateral, side-lying recovery position in the breathing but unresponsive patient was reviewed and published by the International Liaison Committee on Resuscitation (ILCOR) and American Heart Association (AHA).5 Over the timeline of ILCOR's scientific evidence evaluation and review (April 2013 to February 2015), before publication on 15 October 2015, only a few small studies and, at best, low-quality evidence were identified in the literature for outcomes such as ‘incidence of aspiration’, ‘need for airway management’, ‘the likelihood of cervical spinal injury’ and ‘complications’.6 The reviewers found no evidence to address …