Episode 983: Head-of-Bed Position in Large Vessel Occlusion Strokes

Contributor: Aaron Lessen MD

Educational Pearls: 

• Recent prospective randomized clinical trial assessed optimal head-of-bed positioning in patients with LVO
  • 0º vs. 30º elevation
  • Objective was to determine superiority of the two angles in stability prior to thrombectomy for LVO patients
• 45 patients randomized to the group with 0° head positioning and 47 patients randomized to the group with 30° head positioning
  • Patients in the 30º group experienced worsening of NIHSS by 2 points or more
  • Patients with head position at 0° showed score stability
  • Hazard ratio 34.40; 95% CI, 4.65-254.37; P < .001
  • All-cause death occurred in 2 patients in the 0° group, compared with 10 patients in the 30° group.
• Results suggest that 0º positioning of the head of the bed may be protective to maintain clinical stability in patients with LVO prior to thrombectomy

References

1. Alexandrov AW, Shearin AJ, Mandava P, et al. Optimal Head-of-Bed Positioning Before Thrombectomy in Large Vessel Occlusion Stroke: A Randomized Clinical Trial. JAMA Neurol. 2025;82(9):905-914. doi:10.1001/jamaneurol.2025.2253

Summarized & Edited by Jorge Chalit, OMS4

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