Written by Chris Thom
Spoon Feed
This meta-analysis demonstrated that POCUS-guided pulse checks in cardiac arrest are quicker and more accurate than traditional manual pulse checks.
There’s a better way to detect pulses on your arrest patient
This was a meta-analysis of 7 studies that compared POCUS pulse checks to manual pulse checks in cardiac arrest. POCUS use varied between studies, with 5 studies using doppler and 2 using probe compression to detect pulsations of the vessel wall. 5 studies used the carotid artery for POCUS evaluation, while 2 used the femoral artery.
469 pooled participants were included across the 7 studies, with over 2900 ultrasound and 1600 manual pulse checks. POCUS was associated with shorter pulse checks as compared to manual palpation (mean difference of 1.39 seconds, 95%CI -2.2 to -0.57). Overall sensitivity and specificity of manual palpation for presence of pulses was 62% and 91%, as compared to POCUS (99% and 96%).
How will this change my practice?
I suspect we’ll soon see ultrasound become the standard for pulse detection in cardiac arrest. Each time it has been rigorously studied, we’ve found that manual pulse detection has poor accuracy and takes too much time. Given how critical it is to find a pulse quickly, the manual pulse check really should be replaced by something more efficient and accurate. When we have adequate resources in an arrest, we’ve started assigning someone to do pulse checks with a linear ultrasound array through firm probe compression. Automated tools will make this easier in the future.
POCUS Pro-Tips and Clips:
At current state, we need just a bit of POCUS familiarity with the great vessels and how they look in normal physiology in order to adopt this. With firm probe pressure, we’ll see the femoral or internal jugular vein collapse, then we’ll notice the robust mechanical pulsation of the adjacent arterial wall in healthy physiology. The proper amount of probe pressure will effectively collapse the veins and deform the artery about 50%. During arrest and pulselessness, the artery will also fully collapse and there will be no mechanical pulsation of the arterial wall. In “pseudo-PEA” (e.g. pulses are present, but not detected by manual palpation), we’ll see pulsation of the arterial wall during this probe compression.
Source
Duration of resuscitation interruption using point-of-care ultrasound versus traditional manual pulse check: A systematic review and meta-analysis. Am J Emerg Med. 2025 Dec;98:145-152. doi: 10.1016/j.ajem.2025.08.049. Epub 2025 Aug 23. Erratum in: Am J Emerg Med. 2025 Dec;98:430-431. doi: 10.1016/j.ajem.2025.09.047. PMID: 40876216.
