The Sichuan Straddle
February 20, 2011 by Cliff
Filed under All Updates, EMS, Resus
I used to see it done on ‘ER’ but never knew people really straddled patients on stretchers doing CPR. Apparently they do in Sichuan, China and have now produced a manikin study to demonstrate its effectiveness. It might work there, but I imagine there are frequent situations in Australia (where I work) in which the combined weight of patient and paramedic would present an unfair load to the stretcher.
OBJECTIVE: To evaluate the efficacy of straddling external chest compression performed on moving stretchers.
METHODS: The study was a prospective, randomized, cross-over study on a manikin performed at a university hospital. Twenty subjects were selected from the 40 graduates using random numbers to participate in the study. Participants were randomized to either performing standard or straddling external chest compression followed by the other technique 7 days later. The compression variables and time to first compression were recorded.
RESULTS: Twenty subjects (12 males and 8 females) took part in the study. There were no differences between the standard and straddling external chest compression for the compression rate, effective compression percentage and compression depth. There was no difference between the standard external chest compression and straddling external chest compression for incorrect hand position and incomplete release compression. Time to first compression during straddling external chest compression (10.31 ± 1.65 s) was greater than that during standard external chest compression (2.74 ± 0.40 s) (P < 0.001).
CONCLUSIONS: The quality of straddling external chest compression performed on a moving stretcher was as effective as standard external chest compression performed on the floor. By performing straddling external chest compression, time for transporting victims to the emergency department to get advanced life support may be shortened.
The efficacy of straddling external chest compression on a moving stretcher
Resuscitation. 2010 Nov;81(11):1562
I will point out that us Asian people are a uniquely compact study population, in both height and weight. None of the study participants exceeded 72kg!
we also do it frequently here in Austria.
stretchers are usually built for a weight of ~250kg, which is enough for patient+paramedic/nurse/doc
The biggest reason I see to either straddle the patient or “ride” the stretcher (both feet on the support-bar between the wheels, lean over patient and do compressions instead of walking along-side the stretcher) is to minimize interruptions in CPR pre-hospital. Several seconds can pass while loading the stretcher into and out of the ambulance (and we now know it takes a while to build that pressure-head back up), and attempting to compress while walking along-side is nearly impossible to do effectively. I’m definitely guilty of surfing the stretcher into the ER with an arrest victim.. and beyond “looking cool”, I think it actually is better for the patient.
I’ve done the “ride the support bar” thing too. As the smallest/lightest member of my crew I always ended up in that particular spot.
That doesn’t look safe at all!
I would certainly protest if I came across this practice (unless it was a nurse in a skirt…House Of God anyone?)
Seriously, this doesn’t seem right. Give paramedics the means to achieve ROSC on scene, then transport the patient. And give paramedics enough competency to be allowed to call it on scene if ROSC cannot be achieved after the 20-30 minute mark. That should cover a high percentage of cases, for all else maybe those CPR machines could fill in. But not someone sitting on a potential corpse on an already top heavy stretcher…even if it is ‘only’ 70 kg.
[...] from Cliff, if you’re going to do CPR, why not do it Hollywood-style? Turns out the works The Sichuan Straddle [...]
We are a career urban EMS department. We’ve been calling these in the field for over 20 years. We have been doing declarations of death in residences and other locations for at least 30 years. Our litigation rate as an EMS system approaches zero.
Improve the quality of the system and the individual paramedics and a discussion of a topic such as this becomes irrelevant.