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鈥淚鈥檓 lobbying the American Heart Association to consider heel compressions in their CPR guidelines鈥� (Image: Frances Trenkamp)

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鈥� worth of pressure over the breastbone. You might think that鈥檚 not a big deal. But my wife only weighs 52 kg, so it鈥檚 a big deal to me. She can鈥檛 even get 52 kg worth of pressure on to me if she is kneeling down next to me 鈥� 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 鈥� which doesn鈥檛 include rescue breaths 鈥� on a dummy, but found that many couldn鈥檛 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鈥檚 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 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鈥檛 even get down on the floor for health reasons. But more than half could keep compressions up for 10 minutes using their heels (). When we show groups how to do it, invariably someone will say 鈥淚 could do this all day鈥�.

Are you more likely to hurt someone?
As with conventional CPR done with the correct force, you might disarticulate someone鈥檚 ribs 鈥� people call them broken but they鈥檙e usually just snapped off from the breastbone 鈥� but that鈥檚 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鈥檙e 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 and later forgotten. I鈥檓 lobbying the American Heart Association to consider heel compressions in their CPR guidelines.

This article appeared in print under the headline 鈥淥f hearts and heels鈥�