326 Manual Palpation Versus Femoral Arterial Doppler Ultrasound for Comparison of Pulse Check Time During Cardiopulmonary Resuscitation

Introduction: During cardiopulmonary resuscitation, the presence or absence of a pulse is critical in guiding the management of cardiac arrest (CA) patients. Despite the importance placed on palpating a pulse, several reports have shown that providers lack accuracy in determining it the presence via manual palpation. The purpose of this study is to assess the sensitivity, specificity, and accuracy of manual femoral pulse detection as compared to Doppler ultrasound pulse detection in CA patients. Hypothesis: We hypothesize that a Doppler ultrasound obtained pulse will be more accurate than manual palpation for detecting an arterial pulse in patients in CA. Methods: This is a prospective observational study of non-traumatic CA patients that occurred at North Shore University Hospital. During a pulse check, the presence of both a femoral Doppler waveform and manual femoral pulse were recorded simultaneously. These values were compared to the arterial line waveform, which served as the gold standard. During each pulse check, the presence or absence of a pulse was documented, as well as the arterial line measurement. We calculated the sensitivity, specificity, and accuracy of manual palpation and Doppler ultrasound determination of the presence of a pulse. Results: We enrolled a total of 23 patients. The sensitivity of Doppler ultrasound detection of a pulse was 0.82 (95% CI: 0.72, 0.93) with a specificity of 1.00 (95% CI: 1.00, 1.00), and accuracy of 0.88 (95% CI: 0.78, 0.94). The sensitivity and specificity of manual palpation of a pulse was 0.27 (95% CI: 0.15, 0.40) and 0.90 (95% CI: 0.78, 1.00), respectively, with an accuracy of 0.46 (95% CI: 0.34, 0.58). Conclusion: Determining the presence of a pulse in the management of cardiac arrest patients is a critical step in the Advanced Cardiovascular Life Support algorithm. Our preliminary data suggests that Doppler ultrasound has a higher sensitivity and specificity for detecting a pulse in CA patients and highlights the inaccuracy of manual pulse palpation. These preliminary results could lead to a change in the practice of pulse checks, to favor the use of Doppler ultrasound detection. Further data is needed to determine what blood pressure readings correspond to a perfusable rhythm.

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Can pulse check by the photoplethysmography sensor on a smart watch replace carotid artery palpation during cardiopulmonary resuscitation in cardiac arrest patients? a prospective observational diagnostic accuracy study

BMJ Open ◽

10.1136/bmjopen-2018-023627 ◽

2019 ◽

Vol 9 (2) ◽

pp. e023627 ◽

Cited By ~ 1

Author(s):

Yoonje Lee ◽

Hyungoo Shin ◽

Hyuk Joong Choi ◽

Changsun Kim

Keyword(s):

Heart Rate ◽

Cardiac Arrest ◽

Carotid Artery ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

False Negative ◽

Spontaneous Circulation ◽

Smart Watch ◽

Manual Palpation ◽

Pulse Check

ObjectiveThe purpose of this study was to assess whether a photoplethysmography (PPG) sensor in a smart watch can accurately recognise the return of spontaneous circulation (ROSC) in cardiac arrest patients compared with carotid artery palpation.MethodsThis prospective observational study was conducted on 50 out-of-hospital cardiac arrest patients who visited the emergency department (ED) of one tertiary hospital. As soon as the patient arrived at the ED, advanced cardiac life support was carried out immediately. At this time, three smart watches were attached to the carotid artery, forehead and wrist and were checked for pulse measurements every 2 min. In the case of ROSC, blood pressure, heart rate and heart rate regularity were confirmed, and pulse was simultaneously measured at three sites with smart watches. In the case of no ROSC, only the pulse was measured at three sites with the smart watches.ResultsThere were 33 males (66%) and the mean age was 68±11.57 years. In 14 patients (28%), spontaneous circulation was recovered through cardiopulmonary resuscitation, and all survived. The sensitivity and specificity of manual palpation were 78.6% and 90.4%, respectively. False-positive and false-negative rates were 9.6% and 21.4%, respectively. Smart watches at all three sites had the same or higher sensitivity than manual palpation. The sensitivity of the smart watch was the highest, at 100%, in the carotid region and the lowest, at 78.6%, in the wrist region. The specificity of the smart watch was the highest, at 100%, in the wrist region and the lowest, at 78.7%, in the carotid region.ConclusionCompared with manual pulse check, the PPG sensor embedded in the smart watch showed the same sensitivity and a higher specificity for recognising ROSC when measured at the wrist.

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Comparison of femoral and carotid arteries in terms of pulse check in cardiopulmonary resuscitation: A prospective observational study

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2021.04.003 ◽

2021 ◽

Vol 60 (5) ◽

pp. 695-696

Author(s):

Matt Denefe ◽

Nhan “Marc’ Phan ◽

Carly Eastin

Keyword(s):

Cardiopulmonary Resuscitation ◽

Observational Study ◽

Carotid Arteries ◽

Prospective Observational Study ◽

Pulse Check

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Comparison of femoral and carotid arteries in terms of pulse check in cardiopulmonary resuscitation: A prospective observational study

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2021.05.019 ◽

2021 ◽

Vol 60 (6) ◽

pp. 825-826

Author(s):

Matt Denefe ◽

Nhan “Marc’ Phan ◽

Carly Eastin

Keyword(s):

Cardiopulmonary Resuscitation ◽

Observational Study ◽

Carotid Arteries ◽

Prospective Observational Study ◽

Pulse Check

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Application of ultrasound diagnostics in cardiopulmonary resuscitation

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh170308179a ◽

2018 ◽

Vol 146 (5-6) ◽

pp. 323-329

Author(s):

Sladjana Andjelic ◽

Aleksandar Pavlovic ◽

Sladjana Trpkovic ◽

Ana Sijacki ◽

Aleksandra Janicijevic ◽

...

Keyword(s):

Emergency Medicine ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Training Program ◽

Chest Compressions ◽

Liaison Committee ◽

Echocardiographic Evaluation ◽

Ultrasound Diagnostics ◽

Pulse Check ◽

Emergency Doctors

Ultrasound is becoming increasingly available and incorporated into emergency medicine. Focused echocardiographic evaluation in resuscitation (FEER) is a training program available to emergency doctors in order to ensure adequate application of echocardiography in the cardiac arrest setting. The FEER protocol provides an algorithm, whereby a ?quick view? can be provided in 10 seconds during minimal interruptions in chest compressions. Performing ultrasound in the cardiac arrest setting is challenging for emergency doctors. The International Liaison Committee on Resuscitation recommend the ?quick look? echocardiography view can be obtained during the 10-second pulse check, minimizing the disruption to cardiopulmonary resuscitation.

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LO78: Point-of-care ultrasound compared with manual palpation for the detection of a carotid pulse in live models: a randomized cross-over study

CJEM ◽

10.1017/cem.2018.140 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S34-S35

Author(s):

K. Badra ◽

C. Alexandre ◽

R. Simard ◽

J. Lee ◽

J. Chenkin

Keyword(s):

Cardiac Arrest ◽

Health Care Professionals ◽

Comfort Level ◽

Secondary Outcome ◽

Point Of Care Ultrasound ◽

Chest Compressions ◽

Pulse Detection ◽

Comfort Levels ◽

Manual Palpation ◽

Pulse Check

Introduction: Pulse check by manual palpation (MP) is an unreliable skill even in the hands of healthcare professionals. In the context of cardiac arrest, this may translate into inappropriate chest compressions when a pulse is present, or conversely omitting chest compressions when one is absent. To date, no study has assessed the utility of B-mode ultrasound (US) for the detection of a carotid pulse. The primary objective of this study is to assess the time required to detect a carotid pulse in live subjects using US compared to the standard MP method. Methods: This is a prospective randomized controlled cross-over non-inferiority trial. Health care professionals from various backgrounds were invited to participate. They attended a 15 minute focused US workshop on identification of the carotid pulse. Following a washout period, they were randomized to detect a pulse in live subjects either by MP first or by US first. Both pulse check methods were timed for each participant on 2 different subjects. The primary outcome measure was time to carotid pulse detection in seconds. Secondary outcome measures included comfort levels of carotid pulse detection measured on a 100mm visual analog scale (VAS), and rates of prolonged pulse checks (greater than 5 or 10 seconds) for each technique. Mean pulse detection times were compared using Students t-test. The study was powered to determine whether US was not slower than MP by greater than 2 seconds. Results: A total of 93 participants completed the study. Time to detect pulse was 4.2 (SD=3.4) seconds by US compared with 4.7 (SD=6.5) seconds by MP (P=0.43). Seventeen (18%) participants took >5 seconds to identify the carotid pulse using US compared to 19 (20%) by MP (P=0.74). Eight (9%) candidates took >10 seconds to identify the pulse using US compared to 9 (10%) by MP (P=0.81). Prior to training, participants had a higher comfort level using MP than US pulse checks (67 vs 26 mm, P<0.001). Following the study, participants reported higher comfort levels using US than MP (88 vs 78 mm, P<0.001). Conclusion: Carotid pulse detection in live subjects was not slower using US as compared to MP in this study. A brief teaching session was sufficient to improve confidence of carotid pulse identification even in those with little to no previous US training. The preliminary results from this study provide the groundwork for larger studies to evaluate this pulse check method for patients in actual cardiac arrest.

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