Effect of orientation and contact area on foot chest compression quality: a simulation study

Concerns about fatigue and safety have prompted investigation of foot chest compressions as an alternative technique. To evaluate the effect of foot contact area heel vs ball-of-the-foot and foot orientation longitudinal vs transverse on the quality of foot chest compressions and physiological response in healthcare professionals.

This 2 × 2 mixed-design simulation study examined heel and ball-of-the-foot techniques in longitudinal and transverse orientations over the sternum. Participants performed two consecutive two-minute sets of foot chest compressions on a Resusci Anne QCPR manikin. Compression quality parameters included depth, rate, recoil, and compression-to-release ratio. Heart rate was continuously monitored, energy expenditure was estimated using the Keytel equation, and perceived exertion was assessed using the Borg scale. Non-parametric statistical tests were applied with significance set at p < 0.05.

Eighty healthcare professionals completed the study. Mean compression depth ranged from 51 to 55 mm and the rate ranged from 118 to 123 compressions per minute across all conditions. The heel technique produced greater mean compression depth (54.2 ± 6.2 vs 51.6 ± 7.1 mm; p < 0.001), a higher percentage of compressions with adequate depth (81.8 ± 29.8% vs 72.7 ± 34.6%; p < 0.001), and a higher compression-to-release ratio (1.1 ± 0.3 vs 0.9 ± 0.2; p = 0.002) than the ball-of-the-foot technique. Compression rate, complete recoil, energy expenditure, heart rate, and perceived exertion were comparable between techniques. No significant differences were observed between longitudinal and transverse orientations.

Foot chest compressions achieved guideline-consistent depth and rate regardless of foot orientation. The heel technique produced greater mean depth and a higher percentage of adequate-depth compressions than the ball-of-the-foot technique. Physical demand was similar between techniques. These findings support the use of foot chest compressions as a feasible adjunct when hand compressions are not possible and justify further clinical evaluation.