Hand vs. Foot Chest Compressions in Simulation

NCT07074080 | Completed

• 1 other identifier: FOOT-CPR 2025
• Study Type: interventional
• Target: 128
• Locations: 1 country
• Sites: 1

Brief Summary

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 quality. Furthermore, during CPR, it is recommended to rotate rescuers every 2 minutes when two or more rescuers are available due to fatigue associated with the procedure. Current evidence suggests that CPR is most effectively performed in the kneeling position, rather than standing or using a stool, due to the lower levels of fatigue in this position. Traditionally, exercise-induced fatigue is assessed using subjective perception of exertion (RPE), performance monitoring (e.g., power or speed), or biochemical markers (e.g., blood lactate). More recently, heart rate variability (HRV) has been proposed as a valuable tool for assessing the autonomic nervous system response to exercise stress and quantifying physiological fatigue. After exercise, especially if it is intense or prolonged, the body experiences significant physiological stress. This stress affects multiple systems, including the cardiovascular and autonomic nervous systems. Post-exercise fatigue is a complex sensation involving muscular, metabolic, and neuronal factors. Therefore, HRV becomes a valuable biomarker. Numerous studies have shown a correlation between decreased HRV and the subjective perception of fatigue after exercise. People with lower heart rate variability (HRV) after exercise tend to report higher levels of fatigue. HRV analysis provides an objective and physiological measure of the stress the body experiences after short-duration, high-intensity exercise, such as that performed during resuscitation. Therefore, measuring HRV after 2 minutes of chest compressions can indicate the degree of exercise-induced physiological fatigue, which could vary depending on the technique used (Hands-on CPR \[H-CPR\] vs. Feet-on CPR \[F-CPR\]). Efforts to improve outcomes should focus on optimizing the chain of survival through training in Basic Life Support and Automated External Defibrillation (BLS + AED). Offering these courses to the general population presents significant challenges in terms of accessibility and implementation of comprehensive and inclusive training. The objective of our randomized simulation study using mannequins, with a population of Basic Life Support students, was to compare the quality of chest compressions and the fatigue produced by this technique, in compressions performed with the hands and with the foot.

Conditions

Cardiac Arrest (CA)

Keywords

CA (Cardiac Arrest); CPR (Cardiopulmonary Resuscitation); CPR-FOOT (Foot-based Cardiopulmonary Resuscitation); (HRV) Heart Rate Variability

Outcome Measures

Primary Outcomes (2)

• MEAN CHEST COMPRESSION DEPTH

  Data will be collected using the SkillReporter® application (Laerdal Medical®) during 2 minutes of continuous chest compressions on a Resusci Anne QCPR manikin. Primary Variable: Mean chest compression depth: To compare the mean depth of uninterrupted chest compressions (without ventilations) performed over a 2-minute period during a simulated cardiac arrest on the floor using the hands (HM) or the feet in both positions (FM-S and FM-T).

  One day

• DFA α1 (DETRENDED FLUCTUATION ANALYSIS - α1)

  DFA α1 - Short-term scaling exponent from Detrended Fluctuation Analysis (DFA) is a nonlinear HRV metric derived from detrended fluctuation analysis, representing short-term fractal scaling behavior of RR intervals. Assesses fractal-like correlation properties of heart rate time series over short time scales. It provides insights into the complexity and self-regulation of autonomic control. Values closer to 1.0 indicate healthy, adaptable systems, while deviations may suggest altered autonomic regulation. Change in heart rate variability (HRV), measured before and after performing the two minutes of CPR using a certified medical-grade abdominal band device (Movesense®). HRV is a non-invasive indicator of autonomic nervous system (ANS) activity and is known to be affected by physical fatigue and physiological stress.

  One day

Secondary Outcomes (17)

• OVERALL COMPRESSION SCORE

  One day

• TOTAL NUMBER OF COMPRESSIONS

  One day

• COMPRESSION / DESCOMPRESSION RATIO

  One day

• CORRECT COMPRESSION DEPTH

  One day

• COMPRESSION RELEASE

  One day

Study Arms (2)

HM - Hand Method

ACTIVE COMPARATOR

Other: Performance of standard chest compressions with the upper limbs.

FM - Foot Method

EXPERIMENTAL

Other: Performing chest compressions on a mannequin using the foot

Interventions

Performing chest compressions on a mannequin using the foot OTHER

Performing chest compressions on a mannequin using the foot

FM - Foot Method

Performance of standard chest compressions with the upper limbs. OTHER

Performance of standard chest compressions with the upper limbs.

HM - Hand Method

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 years or older
• Signed informed consent
• First-year postgraduate trainees in health-related fields such as medicine or nursing
• Enrolled in a Basic Life Support and Automated External Defibrillation (BLS+AED) course from the Consell Català de Resuscitació - European Resuscitation Council

You may not qualify if:

• Physical limitations preventing chest compressions with hands or feet
• Contraindications for physical exercise (e.g., arthritis, heart disease, advanced lung disease, severe physical disability, morbid obesity, chronic fatigue, pregnancy).

Sponsors & Collaborators

• Hospital Clinic of Barcelona: lead

Study Sites (1)

Facultad de Medicina de La Universidad de Barcelona

Barcelona, BARCELONA, 08036, Spain

Location

MeSH Terms

Conditions

Heart Arrest

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This is a single-center, randomized, crossover, and controlled study conducted at the Skills Laboratory of the Faculty of Medicine and Health Sciences, Campus Clínic. Each participant will serve as their own control, performing chest compressions using both the hands and the foot. The order of the compression method (manual or foot) will be randomly assigned, with participants subsequently performing the alternative method they did not initially complete.

Study Record Dates

• First Submitted: June 5, 2025
• First Posted: July 20, 2025
• Study Start: June 6, 2025
• Primary Completion: June 6, 2025
• Study Completion: June 17, 2025
• Last Updated: July 20, 2025

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will share

Locations

ES (1)