Trendelenburg Position
Perhaps we can begin to treat our patients based more on science than on 150-year-old ritualized procedures - JEMS
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The Myth of the Trendelenburg Position
In World War I, Walter Cannon, an American physiologist, popularized the use of the Trendelenburg position as a treatment for shock. The Trendelenburg position involves the patient being placed with their head down and feet elevated. This position was promoted as a way to increase venous return to the heart, increase cardiac output and improve vital organ perfusion. A decade later, Cannon reversed his opinion regarding the use of the Trendelenburg position, but this didn’t deter its widespread use. The Trendelenburg position is still a pervasive treatment for shock despite numerous studies failing to show effectiveness.
Resources
Emergency Medicine Myth #4: Trendelenburg position to increase blood pressure
The evidence demonstrates that not only does the Trendelenburg position not help patients experiencing hemorrhagic shock, but it can actually be harmful because of effects on both ventilatory and circulatory systems.
Does Trendelenburg belong in the EMS toolkit?
Trendelenburg is taught to all EMS students, but does it still have a place in prehospital care?
Friedrich Trendelenburg (1844–1924) and the trendelenburg position
The name Trendelenburg shall remain eponymously associated with diverse surgical interventions, instruments and clinical signs, but it is ‘his’ ‘Beckenhochlagerung’, the ‘Raised Pelvic Position’, ultimately known as the Trendelenburg Position, that is still being employed by all gynaecologists, surgeons and other health practitioners around the world and that has secured his name indelibly into the annals of medical history.
Myth: The Trendelenburg position improves circulation in cases of shock
Recognizing that the quality of the research is poor, that failure to prove benefit does not prove absence of benefit, and that the definitive study examining the role of the Trendelenburg position has yet to be done, evidence to date does not support the use of this time-honoured technique in cases of clinical shock, and limited data suggest it may be harmful. Despite this, the ritual use of the Trendelenburg position by prehospital and hospital staff is difficult to reverse, qualifying this as one of the many literature resistant myths in medicine.
Trendelenburg Position for the Hypotensive Patient
Current data to support the use of the Trendelenburg position during shock are limited and do not reveal any beneficial or sustained changes in systolic blood pressure or cardiac output.
The Myth of the Trendelenburg Position
In World War I, Walter Cannon, an American physiologist, popularized the use of the Trendelenburg position as a treatment for shock. The Trendelenburg position involves the patient being placed with their head down and feet elevated. This position was promoted as a way to increase venous return to the heart, increase cardiac output and improve vital organ perfusion. A decade later, Cannon reversed his opinion regarding the use of the Trendelenburg position, but this didn’t deter its widespread use. The Trendelenburg position is still a pervasive treatment for shock despite numerous studies failing to show effectiveness.
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