Mechanical differences between standard arm and foot chest compressions: a randomised crossover study

The standard method of resuscitation chest compression (CC) is the two-handed chest compression (HCC), whereas the quality of foot chest compressions (FCCs) has not yet been sufficiently investigated. This study aimed to compare the mechanical characteristics of foot and two-handed chest compressions to identify differences in quality and potential safety concerns between HCCs and FCCs.

This was a randomised crossover manikin study. The outcomes measured included the time course of the magnitude and direction of the force exerted by the manikin on the force plate during resuscitation and components of high-quality CCs.

While the maximal force exerted during FCCs was approximately 5 % lower than during HCCs, the angle of this maximal force from the vertical was nearly twice as large in FCCs (p < 0.0001). Participants performing FCCs achieved a lower mean CC depth (p < 0.001), consistent with the smaller maximal force. The rate of FCCs was slower than that of HCCs (p < 0.001), and the total number of compressions performed differed significantly between the two methods (p < 0.001).

The method of compression influences both the magnitude and angle of the force applied. FCCs were associated with significantly lower quality metrics. Nevertheless, on average, participants in both groups achieved CC parameters that were within or close to the recommended guideline ranges.