Posted on 11/14/2012

LOS ANGELES--Is “Heel CPR” a viable alternative to “Hands-Only CPR” for lone rescuers, who may become fatigued and unable to apply adequate force while waiting for EMS to arrive?

Fernando Perez, MD, and Robert H. Trenkamp, Jr., EMT-P, from “Saving Lives in Chatham County explored this question and presented their research earlier this month at the American Heart Association Resuscitation Science Symposium. 

Trenkamp, who serves on the Sudden Cardiac Arrest Foundation Board of Directors, reported the results of examining the duration an adult could maintain two-inch deep chest compressions at a rate of at least 100 per minute using “Hands-Only” and then Pedal Compressions (“Heel CPR”) in two sequential tests. 

The test subjects were all 35 years old or older, and half of the cohort was between 50-80 years old. Fewer than 20 percent of the cohort was able to perform two-inch manual chest compressions for four minutes at the required one hundred per minute or higher rate.

In contrast, more than 60 percent of study participants were able to perform two-inch pedal compressions for 10 minutes at that rate—and those subjects felt that they could easily performed adequate depth and rate pedal compressions for another extended period, if necessary. (The tests were all halted at 10 minutes.)

This is significant for two reasons. First, it is exceedingly rare to have the EMS crew at the cardiac arrest victim’s side within four minutes of the arrest. Second, the average response time for EMS, measured from the time of arrest to the time when they are “hands on,” is 9.7 minutes.

The first point suggests that manual compressions will not be adequate when there is not an additional person present to trade off with the initial rescuer, even if EMS arrives very quickly. The second point suggests that pedal compressions would be adequate in at least 60 percent of arrests.

The “leg-heel method” was originally proposed in more than 30 years ago by Laurence Billfield and Gary Regula (JAMA 239:2468-2469, 1978). According to Trenkamp, "The reason that pedal CPR was not adopted then is that it was tested in a far less-demanding environment: The compression rate was 60 per minute, the depth was one to one and a half inches, the total test cycle was five minutes, the test subjects were young medical students, and the manikins used were more representative of the average chest stiffness, as opposed to being at a stiffness as great as or greater than most of the population."

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