Written by Chris Thom
Spoon Feed
This study compared carotid artery versus subxiphoid cardiac POCUS during out-of-hospital cardiac arrest by EMS providers. Carotid POCUS was associated with shorter compression pauses and higher rates of adequate imaging.
Consider carotid ultrasound during cardiac arrest
This was an observational study of EMS providers during out-of-hospital cardiac arrest (OHCA). EMS providers were given discretion on whether to start with the carotid or subxiphoid view and instructed to alternate between these for a given patient’s OHCA. Outcomes analyzed were the imaging adequacy of each view and the compression pause durations.
There were 107 OHCA patients included in the analysis, with a total of 248 ultrasound videos. 127 of these were carotid views and 121 were subxiphoid views. The carotid image resulted in an adequate view 83% of the time compared to the subxiphoid view at 39%, p < 0.001. The percentage of CPR pauses that were less than 10 seconds with the carotid view was 83% compared to 63% for the subxiphoid view, p < 0.001.
How will this change my practice?
Carotid ultrasound during arrest is feasible by EMS providers. While the subxiphoid view and carotid artery admittedly can provide separate and distinct information (e.g. pericardial tamponade in the subxiphoid view and evidence of carotid pulses in the carotid artery view), this study makes a good point. Carotid artery ultrasound is simply easier and quicker to perform, with a lower barrier to entry with regard to operator expertise. It can be a useful tool in determining if pulses are present and has been shown to have higher accuracy than traditional manual pulse check. One loses the ability to detect pericardial tamponade and RV strain, but perhaps that omission is worth the benefit in the out-of-hospital EMS setting.
POCUS Pro-Tips
Carotid artery ultrasound is exceedingly easy. Place the linear transducer just lateral of midline in the mid anterior neck. You’ll often see the trachea, thyroid, and the great vessels (carotid artery and internal jugular vein). The carotid artery is reliably round and has a slightly thicker wall than the more variably shaped IJ. You’ll apply enough pressure to deform the artery about one-third to halfway. At this point, you’ll assess whether the artery has pulsatility. Importantly, the probe can be brought onto the field during compressions so that the assessment during the compression pause is quick and does not delay resumption of CPR.
Source
Delays in chest compressions during out-of-hospital cardiac arrest: carotid versus subxiphoid point of care ultrasound. Resuscitation. 2026 Feb;219:110953. doi: 10.1016/j.resuscitation.2025.110953. Epub 2025 Dec 30. PMID: 41478585.
