Leg-foot chest compressions: a scoping review

Objectives

High-quality chest compressions (CCs) are vital for the return of spontaneous circulation. When hand CCs are difficult, leg-foot CCs may offer an alternative. We reviewed existing studies to describe the current evidence and identify gaps in the literature regarding this technique and its impact on outcomes.

Methods

Between November and December 2024, we conducted a scoping review, searching eight databases, two proceedings (Resuscitation 2024 and the Resuscitation Science Symposium 2024), a trial register, animal guidelines, citations, and reference lists. We included studies on leg-foot CCs performed on humans, animals, or manikins by laypersons, healthcare professionals, pre-licensure students, or duty-to-respond laypersons. The intervention was leg-foot CCs; the comparison was standard hand CCs. Outcomes were feasibility, acceptability, and effectiveness (rate, depth, recoil, location). Eligible designs included trials, non-randomised studies, case reports, and research letters with English abstracts from 1960 to 2024.

Results

Out of 1173 records, we identified 14 studies comparing leg-foot and hand CCs, all using manikins, mostly from Western countries (11/14 studies). No human studies were identified. Twelve compared depth, nine rate, six recoil, and eight location. Most studies found no significant subgroup differences, though some reported better performance in heavier participants or when using a balance aid. Several studies observed differences in rate, recoil, and location overall. Of five studies assessing fatigue, two favoured leg-foot CCs, one was mixed, and two favoured hand CCs.

Conclusion

No human studies of leg-foot CCS were identified. On manikins, leg-foot CCs are feasible and may reduce fatigue, but results vary. More research, including animal or human studies, is needed.