There is significant published evidence calling into question the utility and accuracy
of manual pulse palpation during cardiopulmonary resuscitation (CPR) for determining
return of spontaneous circulation (ROSC).
1
,
2
,
3
Despite this clinical equipoise, manual palpation remains the primary modality for
determination of ROSC and is still the only method recommended in the current adult
basic and advanced life support guidelines.
4
There is growing evidence that bedside ultrasound may be a more accurate alternative
to manual pulse palpation in a variety of different modalities; transthoracic echocardiography
(TTE), transesophageal echocardiography (TEE) and color arterial doppler.
5
,
6
,
7
,
8
TTE has proven to be feasible, though has been criticized for delaying time off the
chest due to higher technical skill required to obtain images.
9
,
10
TEE mitigates some of this concern, though it is not practical in all practice environments
primarily due to transducer availability and provider credentialing to perform this
exam.
- Gaspari R.
- Harvey J.
- DiCroce C.
- et al.
Echocardiographic pre-pause imaging and identifying the acoustic window during CPR
reduces CPR pause time during ACLS - A prospective Cohort Study.
Resusc Plus. 2021; 6100094https://doi.org/10.1016/j.resplu.2021.100094
7
Doppler ultrasound of large arteries however is easy to perform and could prove to
be a replacement for manual palpation.To read this article in full you will need to make a payment
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References
- Accuracy of pulse checks in terms of basic life support by lifesavers, as lay persons.Circ J. 2010; 74: 1895-1899https://doi.org/10.1253/circj.cj-10-0081. 5
- Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse.Resuscitation. 1996; 33: 107-116https://doi.org/10.1016/s0300-9572(96)01016-7. 6
- The carotid pulse check revisited: What if there is no pulse?.Critical Care Med. 2000; 28: N183
- Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2020; 142: S366-S468https://doi.org/10.1161/CIR.0000000000000916
- Comparison of manual pulse palpation, cardiac ultrasonography and Doppler ultrasonography to check the pulse in cardiopulmonary arrest patients.Resuscitation. 2018; 133: 59-64https://doi.org/10.1016/j.resuscitation.2018.09.018
- The POCUS pulse check: A randomized controlled crossover study comparing pulse detection by palpation versus by point-of-care ultrasound.Resuscitation. 2019; 139: 17-23https://doi.org/10.1016/j.resuscitation.2019.03.009
- Transesophageal Echocardiography During Cardiopulmonary Resuscitation Is Associated With Shorter Compression Pauses Compared With Transthoracic Echocardiography.Ann Emerg Med. 2019; 73: 610-616https://doi.org/10.1016/j.annemergmed.2019.01.018
- Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest.Resuscitation. 2022; 173: 156-165https://doi.org/10.1016/j.resuscitation.2022.01.030
- Feasibility of focused cardiac ultrasound during cardiac arrest in the emergency department.Cardiovasc Ultrasound. 2021; 19: 19https://doi.org/10.1186/s12947-021-00252-3
- Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS - A prospective Cohort Study.Resusc Plus. 2021; 6100094https://doi.org/10.1016/j.resplu.2021.100094
- Gray-Scale, Color Doppler, Spectral Doppler, and Contrast-Enhanced Renal Artery Ultrasound: Imaging Techniques and Features.J Clin Med. 2022; 11: 3961https://doi.org/10.3390/jcm11143961
- Carotid duplex criteria: What have we learned in 40 years?.Semin Vasc Surg. 2020; 33: 36-46https://doi.org/10.1053/j.semvascsurg.2020.05.003
- Do Not Get It Twisted: Common and Uncommon Manifestations of Testicular Torsion.J Ultrasound Med. 2022; 41: 271-283https://doi.org/10.1002/jum.15723
- Doppler Ultrasound Peak Systolic Velocity versus End Tidal Carbon Dioxide during Pulse Checks in Cardiac Arrest.Resuscitation. 2023; 183: 109695
- Optimizing Image Quality When Evaluating Blood Flow at Doppler US: A Tutorial.Radiographics. 2019; 39: 1501-1523https://doi.org/10.1148/rg.2019180055
Article info
Publication history
Published online: February 03, 2023
Accepted:
January 24,
2023
Received:
January 23,
2023
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
