Hand vs. Foot Chest Compressions in Simulation

Cardiopulmonary resuscitation (CPR) is essential in the management of cardiorespiratory arrest (CA) to improve survival rates. High-quality chest compressions are the primary intervention to maintain circulation and oxygenation of vital organs during cardiac arrest, making them a key determinant in CPR effectiveness. Guidelines emphasize that the quality of chest compressions is a critical factor in the effectiveness of basic life support (BLS). To ensure efficacy, a compression rate of 100 to 120 per minute is recommended, with a depth of at least 5 cm but not exceeding 6 cm, proper arm and hand alignment, full chest recoil after each compression, minimal interruptions during CPR, and rescuer rotation every 2 minutes to prevent performance decline due to fatigue. As we can see, these guidelines refer to performing compressions using the upper limbs. However, it is essential to acknowledge that some individuals have physical limitations that may impair their ability to apply effective force with their upper limbs (e.g., amputations, fractures, neuromuscular dysfunctions). This presents important challenges regarding accessibility and inclusive CPR training. In addition, the use of the lower extremities has been proposed as an alternative to potentially reduce rescuer fatigue, although evidence regarding its effectiveness and impact on physiological fatigue is still limited. There are studies comparing chest compressions performed with the hands (Hands Method, HMM) and with the feet (Foot Method, FMM); however, these studies have certain limitations and a limited number of participants. Although the quality of CPR was lower when using the feet technique, the results were positive. However, to date, no specific guidelines have been established on how to perform CPR using the feet (Foot CPR), and it remains unclear whether the position of the feet on the chest or whether compressions are performed with or without shoes are variables that influence compression quali