Comparing foot and hand cardiopulmonary resuscitation: a non-inferiority, crossover, randomised controlled simulation study

Background: High-quality chest compression is crucial during cardiopulmonary resuscitation. The present simulation study aimed to evaluate whether the chest compression method using the foot is comparable to that using the hand. Methods: This was a prospective, crossover, non-inferiority, randomised controlled simulation study. Non-inferiority tests were conducted for chest compression depth and rate. To determine non-inferiority, the lower limit of the confidence interval was compared to a pre-specified inferiority margin of −5 mm for chest compression depth. The compression rate was analysed in the same manner, with −17 compressions/min as the inferiority margin. Results: Seventy-two participants were enrolled in this study. The mean chest compression depth was 53.3 (±5.6) mm with foot chest compression (FCC) and 51.5 (±5.8) mm with hand chest compression (HCC). The mean difference between FCC and HCC was 1.8 (95% confidence interval (CI), −0.1 to 3.7) and FCC was not inferior to HCC in compression depth. The mean chest compression rates were 107.6/min and 112/min for FCC and HCC, respectively. The mean difference between FCC and HCC was −4.5/min (95% CI, −1.6 to −7.3) and FCC was not inferior to HCC for the chest compression rate. Conclusions: The results suggest that chest compression using the foot showed non-inferior performance regarding compression depth and rate compared with chest compression using the hand after brief training. Clinical Trial Registration: NCT06719401.