Abstract
Background
Traditional assessment of return of cardiac output in cardiac arrest by manual palpation
has poor accuracy. Point of care ultrasound of a major artery has been suggested as
an alternative. We conducted a diagnostic accuracy study of two-dimensional carotid
ultrasound to detect the presence or absence of a pulse, using cardiopulmonary bypass
patients for pulse and pulseless states.
Methods
A cross-sectional multi-patient, multi-reader repeated measures diagnostic study was
conducted. For patients undergoing routine cardiopulmonary bypass, a portable ultrasound
was used to record four 10-s videos the common carotid artery, three aimed for a pulse
in high (>90 mmHg), medium (70−90 mmHg) and low (<70 mmHg) systolic blood pressure
(SBP) ranges, and a pulseless video was recorded on cardiopulmonary bypass. Critical
care physicians viewed the videos and were asked to nominate within 10 s if a pulse
was present. True pulse-status was determined via the arterial-line waveform.
Results
Twenty-three patients had all four videos collected. Median patient age was 64 (IQR
14), sixteen were male (70%) and median BMI was 27. The median SBP in high-, medium-
and low-SBP groups were 120 mmHg, 83 mmHg and 69 mmHg respectively. Forty-six physicians
reviewed a subset of 24 videos. Overall sensitivity was 0.91 (95% confidence interval
0.89−0.93) and specificity 0.90 (95% CI 0.86−0.93). Sensitivity was highest in the
high-SBP group (0.96, 95% CI 0.93−0.98) and lowest in the low-SBP group (0.83, 95%
CI 0.78−0.87).
Conclusion
2D ultrasound of the common carotid artery is both sensitive and specific for detection
of the presence or absence of a pulse.
Keywords
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References
- Heart disease and stroke statistics 2019 update: a report from the American Heart Association.Circulation. 2019; 139: 56-528
- Part 7: adult advanced cardiovascular life support: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2015; 132: S444-64
- 2019 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.Resuscitation. 2019; 145: 95-150
- Skills of lay people in checking the carotid pulse.Resuscitation. 1997; 35: 23-26
- Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study.BMJ. 2000; 321: 673
- Competence of health professionals to check the carotid pulse.Resuscitation. 1998; 37: 173-175
- Basic cardiac life support providers checking the carotid pulse: performance, degree of conviction, and influencing factors.Acad Emerg Med. 2004; 11: 878-880
- Checking the carotid pulse: diagnostic accuracy in students of the healthcare professions.Resuscitation. 2000; 44: 195-201
- Cardiopulmonary resuscitation: errors made by pre-hospital emergency medical personnel.Resuscitation. 1999; 42: 47-55
- The carotid pulse check revisited: What if there is no pulse?.Critical Care Med. 2000; 28: N183-N185
- Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse.Resuscitation. 1996; 33: 107-116
- Reliability of pulse palpation by healthcare personnel to diagnose paediatric cardiac arrest.Resuscitation. 2009; 80: 61-64
- ANZCOR Guideline 11.2 – Protocols for Adult Advanced Life Support.2018 (8)
- Return of spontaneous circulation confirmed by two dimensional ultrasound following pulseless electrical activity arrest.Anaesth Cases. 2015; 3: 20-22
- The POCUS pulse check: a case series on a novel method for determining the presence of a pulse using point-of-care ultrasound.J Emerg Med. 2019; 56: 674-679
- Tools for the analysis of epidemiological data.1.0-14 ed. 2020
- Cardiopulmonary resuscitation techniques and instruction: when does evidence justify revision?.Ann Emerg Med. 1999; 34: 780-784
- The POCUS pulse check: A randomized controlled crossover study comparing pulse detection by palpation versus by point-of-care ultrasound.Resuscitation. 2019; 139: 17-23
- Variation of availability and frequency of emergency physician-performed ultrasonography between adult and pediatric patients in the academic emergency department in Korea.Clin Exp Emerg Med. 2015; 2: 16-23
- Changes in the availability of bedside ultrasound practice in emergency rooms and prehospital settings in France.Anaesth Crit Care Pain Med. 2018; 37: 201-205
- Emergency clinician performed ultrasound: Availability, uses and credentialing in Australian emergency departments.Emerg Med Austral. 2010; 22: 296-300
- Learning curves in emergency ultrasound education.Acad Emerg Med. 2015; 22: 574-582
- Rapid cardiac ultrasound of inpatients suffering PEA arrest performed by nonexpert sonographers.Resuscitation. 2005; 67: 81-87
- Variability in interpretation of cardiac standstill among physician sonographers.Ann Emerg Med. 2018; 71: 193-198
- Electromechanical dissociation in human beings: an echocardiographic evaluation.Ann Emerg Med. 1988; 17: 450-452
- Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review.Acad Emerg Med. 2012; 19: 1119-1126
- Impact of modified treatment in echocardiographically confirmed pseudo-pulseless electrical activity in out-of-hospital cardiac arrest patients with constant end-tidal carbon dioxide pressure during compression pauses.J Int Med Res. 2010; 38: 1458-1467
- Comparison of manual pulse palpation, cardiac ultrasonography and Doppler ultrasonography to check the pulse in cardiopulmonary arrest patients.Resuscitation. 2018; 133: 59-64
- Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions.Resuscitation. 2017; 119: 95-98
- The reliability of carotid ultrasound in determining the return of pulsatile flow: a pilot study.Ultrasound. 2018; 26: 118-126
- Static filling pressure in patients during induced ventricular fibrillation.Am J Physiol Heart Circ Physiol. 2003; 285: H2510-H2515
Article info
Publication history
Published online: October 12, 2020
Accepted:
October 1,
2020
Received in revised form:
September 8,
2020
Received:
July 6,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.