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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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.
