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Wednesday, November 4, 2015

It worked

The Short Version
An elderly male suffered a cardiac arrest at a meeting. Another elderly male began to perform manual CPR but quickly tired and was unable to continue. The other person present - who had recently read an interview with one of the authors of an article in the American Journal of Emergency Medicine regarding Heel Compression CPR began to perform Heel CPR. The victim's heart was restarted before the arrival of EMS.

That's the whole point of Heel CPR - when you cannot get down on the ground or you have a problem pressing hard enough on the chest to get adequate compression depth, consider an alternative: Heel CPR. Go to and click on the Adult CPR video.

Dr. Perez and I wrote a paper about the advantages of Heel Compression CPR. It was promptly published in the American Journal of Emergency Medicine. We wrote the article describing our research so that organizations such as the American Heart Association and the American Red Cross would have a peer-reviewed basis for considering the adoption of the technique in their Bystander course curricula.

Because 85% of cardiac arrests occur in the home - and about half are witnessed - the witness is generally about the same age as the victim. Because of the age distribution of the victims, the witness / rescuer is likely to be unable to perform CPR in the same manner as a medical student or Intern - the typical cohort in a CPR study. Many cannot get down on the floor. Many have arthritis or other afflictions of the hands or arms that reduce their ability to perform Guideline-Compliant Chest Compressions ("GC3's"). It was for this reason that we developed Heel Compression CPR.

Heel Compression CPR enables four times as many people to perform GC3's. Here's the abstract from the AJEM publication:

Heel compressions quadruple the number of people who can perform chest
compressions for ten minutes.


Objective: To evaluate whether chest compressions using the heel provide a more
effective method than manual compressions for bystanders.

Methods: 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 (“SCA”) victims, were asked to perform ten minutes of five
cm manual compressions on a CPR 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 ten minutes of heel compressions at the same depth and rate.

Results: Sixteen percent of the cohort performed compliant manual compressions for ten
minutes versus sixty-five percent using heel compressions. Twenty-four percent of the
subjects were not heavy enough to get compliant depth with manual vs. two percent with
heel compressions, and six percent could not get down on the floor to attempt manual

Discussion: 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.
Heel compressions quadruple the number of people who can perform chest
compressions for ten minutes.