Head-of-Bed Positioning Impact on Patients' Recovery Following Thrombectomy: Anne W. Alexandrov PhD, RN, CCRN, ANVP-BC, NVRN-BC, FAAN

WATCH TIME: 6 minutes

"Our study shows that head-of-bed positioning at 0 degrees, rather than 30 degrees, significantly enhances patients' stability and reduces disability, leading to less days in rehabilitation.”

Previous research in patients with large vessel occlusion (LVO) prior to undergoing thrombectomy showed a significant 20% increase in blood flow and improvements in the clinical exam when patient’s head was placed at 0-degrees.1 In a recent study presented at the 2024 International Stroke Conference (ISC), February 7-9, in Phoenix, Arizona, by lead author Anne W. Alexandrov PhD, RN, CCRN, ANVP-BC, NVRN-BC, FAAN, findings showed that 0-degree head positioning imparted stability and clinical improvement in patients with LVO thrombectomy. These results suggest that clinicians should use 0-degree positioning as the standard of care in the pre-thrombectomy period for patients to optimize brain perfusion.1

This multisite prospective randomized outcome-blinded evaluation trial (NCT03728738), otherwise known as ZODIAC, was conducted examining 0- and 30-degree head positioning stability in patients LVO prior to thrombectomy. The primary end point was early neurologic deterioration before thrombectomy and safety end points included aborted positioning because of severe deterioration, hospital acquired pneumonia, and death. The exploratory end points included 24-hour and discharge/7-day National Institutes of Health Stroke Scale score, and 3-month Modified Rankin Score.

Alexandrov, professor of nursing and neurology at the University of Tennessee Health Science Center (UTHSC), recently had a conversation with NeurologyLive® during the meeting to discuss how the ZODIAC study challenged existing practices in thrombectomy patient care. She also talked about the primary and exploratory end points of the study, and the surprising findings that emerged from the research. Additionally, Alexandrov, who also serves as the chief nurse practitioner of the UTHSC Mobile Stroke Unit, spoke about how the study overcame challenges posed by the COVID-19 pandemic to ensure comprehensive data collection and analysis.

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REFERENCES
1. Alexandrov AW, Shearin AJ, Torrealba-Acosta G, et al. Zero Degree Head Positioning in Acute Large Vessel Ischemic Stroke (ZODIAC). Presented at: 2024 International Stroke Conference; February 7-9; Phoenix, AZ. Abstract LB1.