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How to Use POCUS for Pulse Checks – Is Manual Palpation Passé?

August 12, 2022

Written by Megan Hilbert

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Point-of-care ultrasound carotid artery compression (POCUS-CAC) was quicker than manual palpation (MP) in determining return of spontaneous circulation (ROSC).

Why does this matter?
Manual palpation of central pulses during CPR is notoriously unreliable and can frequently lengthen pulse checks. While studies have demonstrated that ultrasound can also lengthen pulse checks, these authors detail a method that has been shown to be quicker than MP for pulse determination and evaluation of ROSC.

Probe on the neck may mean less time off the chest
This was a single-center, prospective trial with a small sample size (25) of both in-hospital and out-of-hospital cardiac arrests that underwent CPR in the ED. After initiation of compressions, a linear probe was placed in transverse orientation over the middle of the neck with the goal of identifying the internal jugular vein and carotid artery. Slow graded compression was then applied – if the carotid artery was completely compressible or had lack of pulsatility it was determined that the patient was pulseless with 90% sensitivity and specificity.

The primary outcome was the average time for pulse determination by POCUS-CAC as compared to MP (completed at the femoral artery to prevent dual carotid compression) which was 1.62 and 3.5 seconds, respectively. Secondary outcomes demonstrated that pulse checks with POCUS-CAC never exceeded 10 seconds, and time to ROSC determination was reduced to 0.44 times that of MP (P<0.001), even in hypotensive states.

These are encouraging findings, but limitations exist; namely, there was no demonstrated improvement in patient-centered outcomes, with only 10 patients achieving ROSC and only 1 surviving to discharge.

Editor’s Note: The physician doing manual palpation was doing a pulse determination AND deciding if ROSC was achieved in conjunction with the rhythm. That’s a much higher cognitive load for only one side of the comparison and is not quite apples to apples. ~ Nick Zelt

Point-of-care ultrasound compression of the carotid artery for pulse determination in cardiopulmonary resuscitation. Resuscitation. 2022 Jul 2;S0300-9572(22)00590-1. doi: 10.1016/j.resuscitation.2022.06.025. Online ahead of print.

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