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Jun 11, 2017
The objective of the study is to evaluate whether chest compressions using the heel provide a more effective method than manual compressions for bystanders.
This is a cross-sectional observational comparison study where each subject acted as his or her own control. A 49-person cohort whose age distribution approximated that of sudden cardiac arrest victims were asked to perform 10 minutes of 5-cm manual compressions on a cardiopulmonary resuscitation manikin at 100 compressions per minute. The compression rate and the endurance of each subject were recorded. The same subject was then asked to perform 10 minutes of heel compressions at the same depth and rate.
Sixteen percent of the cohort performed compliant manual compressions for 10 minutes vs 65% using heel compressions. Twenty-four percent of the subjects were not heavy enough to get compliant depth with manual vs 2% with heel compressions, and 6% could not get down on the floor to attempt manual compressions.
Most cardiac arrests occur in private residences. If there is a witness, his or her age usually approximates that of the victim. Heel compressions are useful in situations where a lone rescuer cannot get down on the floor, cannot compress the chest to guideline depth because of an infirmity or lack of weight, or becomes too tired to continue manual compressions. Heel compressions significantly increase the bystander population's ability to provide effective, uninterrupted compressions until EMS arrival.
Conventional CPR might exhaust a first-aider before the ambulance arrives, says paramedic Bob Trenkamp, who developed an alternative method.
HEALTH 5 August 2015
“I’m lobbying the American Heart Association to consider heel compressions in their CPR guidelines”
Do you think there is a problem with the way CPR is performed?
To compress the adult chest to the roughly 2 inches (5 centimetres) required to keep a heart pumping after a cardiac arrest, you need to exert around 59 kilograms’ worth of pressure over the breastbone. You might think that’s not a big deal. But my wife only weighs 52 kg, so it’s a big deal to me. She can’t even get 52 kg worth of pressure on to me if she is kneeling down next to me – but at least she can do it with her heel if she stands up.
How did you come up with the idea of using the heel to perform CPR?
I live in a retirement community where a lot of people have arthritic wrists and arms. I was training people here to perform hands-only CPR – which doesn’t include rescue breaths – on a dummy, but found that many couldn’t push hard enough to get to the 1.5-inch mark at which the dummy clicks. I got frustrated, so I took a guy and said: look, use this chair for support and try doing it with your heel.
How do you do standing chest compressions?
You take your shoes off and stand with your toes next to the tops of someone’s ears, facing their feet. Then you put a heel at the centre of their chest, between the nipples, and start pushing down twice a second. You can hum Stayin’ Alive by the Bee Gees to keep yourself in time.
Is doing CPR while standing up easier?
Cardiac arrest most commonly affects older people at home. Often these people are living with a partner of a similar age. We asked 44 people who were the typical age of those at risk of cardiac arrest to perform hand-based chest compressions on a dummy for 10 minutes, which is the average time for an ambulance to respond to a call here in Chatham County. Only seven of them could do it. Three of them couldn’t even get down on the floor for health reasons. But more than half could keep compressions up for 10 minutes using their heels (The American Journal of Emergency Medicine, doi.org/6ht). When we show groups how to do it, invariably someone will say “I could do this all day”.
Are you more likely to hurt someone?
As with conventional CPR done with the correct force, you might disarticulate someone’s ribs – people call them broken but they’re usually just snapped off from the breastbone – but that’s better than being dead. Having a disarticulated rib will keep someone sore for 60 days. Not pressing hard enough to potentially break something will keep them dead forever, because you’re not applying enough pressure. A benefit of the ribs disarticulating is that it becomes easier to compress the chest to the correct depth.
Will this method enter official guidelines?
When we started teaching this six years ago, we thought we had invented it. But then I found out that a version was developed for CPR guidelines back in 1978 and later forgotten. I’m lobbying the American Heart Association to consider heel compressions in their CPR guidelines.
Bob Trenkamp is a paramedic, a teacher of cardiopulmonary resuscitation (CPR) and the president of Saving Lives in Chatham County, a cardiac arrest and stroke charity based in Savannah, Georgia
This article appeared in print under the headline “Of hearts and heels”
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