1368: SIZE DOESN’T MATTER: DETERMINING ASSOCIATION BETWEEN BMI AND PULSE CHECK LENGTH IN CARDIAC ARREST

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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Video Case Review for Quality Improvement During Cardiac Arrest Resuscitation in the Emergency Department

10.22541/au.161675625.52339453/v1 ◽

2021 ◽

Author(s):

Joseph Brooks ◽

Ayal Pierce ◽

Patrick McCarville ◽

Natalie Sullivan ◽

Anahita Rahimi-Saber ◽

...

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Quality Improvement ◽

Quality Metrics ◽

Senior Resident ◽

Quality Improvement Initiative ◽

Case Review ◽

Video Review ◽

Review Team ◽

Pulse Check

Background: Cardiac arrests (CA) are a leading global cause of mortality. The American Heart Association (AHA) promotes several important strategies associated with improved cardiac arrest outcomes, including decreasing pulse check time and maintaining a chest compression fraction (CCF) > 0.80. Video review is a potential tool to improve skills and analyze deficiencies in various situations, however its use in improving medical resuscitation remains poorly studied in the emergency department (ED). We implemented a quality improvement initiative, which utilized video review of cardiac arrest resuscitations in an effort to improve compliance with such AHA quality metrics. Methods: A cardiopulmonary resuscitation Video Review Team (CoVeRT) of emergency medicine residents were assembled to analyze CA resuscitations in our urban academic ED. Videos were reviewed by two residents, one of whom was a senior resident (PGY-3 or -4), and analyzed for numerous quality improvement metrics, including pulse check time, CCF, time to intravenous access, and time to patient attached to monitor. Results: We collected data on 94 cardiac arrest resuscitations between July 2017 and June 2020. Average pulse check time was 13.09 (SD ±5.97) seconds, and 38% of pulse checks were less than 10 seconds. After the implementation of the video review process, there was a significant decrease in average pulse check time (p=0.01) and a significant increase in CCF (p=0.01) throughout the study period. Conclusions: Our study suggests that the video review and feedback process was significantly associated with improvements in AHA quality metrics for resuscitation in CA among patients presented to the ED.

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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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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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First do no harm: Echocardiography during cardiac arrest may increase pulse check duration

Resuscitation ◽

10.1016/j.resuscitation.2017.08.006 ◽

2017 ◽

Vol 119 ◽

pp. A2-A3 ◽

Cited By ~ 2

Author(s):

Ari Moskowitz ◽

Katherine M. Berg

Keyword(s):

Cardiac Arrest ◽

Do No Harm ◽

Pulse Check

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Feasibility of correlating the pulse check with focused point-of-care echocardiography during pediatric cardiac arrest: A case series

Resuscitation ◽

10.1016/j.resuscitation.2007.12.015 ◽

2008 ◽

Vol 77 (2) ◽

pp. 264-269 ◽

Cited By ~ 38

Author(s):

James W. Tsung ◽

Michael Blaivas

Keyword(s):

Cardiac Arrest ◽

Point Of Care ◽

Case Series ◽

Pulse Check

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Abstract 14095: Use of Femoral Arterial Doppler Velocity to Detect Perfusing Pulses During Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.14095 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

allison cohen ◽

Timmy Li ◽

Lance B Becker ◽

Allen Gold ◽

mathew nelson ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Femoral Artery ◽

Maximum Velocity ◽

Arterial Line ◽

Optimal Cutoff ◽

Cutoff Value ◽

Doppler Waveform ◽

Manual Palpation ◽

Pulse Check

Introduction: Manual pulse detection is inaccurate in cardiac arrest(CA) and Doppler ultrasound may detect blood flow without an adequate perfusion blood pressure (pseudo-pulseless electrical activity). The purpose of this study is to assess whether maximum femoral arterial velocity during a pulse check is correlated with arterial line systolic blood pressure (SBP) and whether it can be used to accurately identify a SBP of ≥60mmHG. Methods: This is a prospective study of CA patients at a quaternary care Emergency Department. During a pulse check, a linear ultrasound was placed at the common femoral artery and the presence or absence of an arterial Doppler waveform, the associated maximum velocity value, and arterial line SBP were recorded simultaneously. The correlation between SBP and maximum waveform velocity was assessed. Arterial SBPs were dichotomized as <60mmHG or ≥60mmHg, as this was deemed as an adequate perfusion pressure, and a receiver operator characteristic curve analysis was performed to determine optimal cutoff value of maximum velocity associated with SBP ≥60mmHG. Sensitivity (Sn), specificity (Sp), and accuracy (Acc) of manual palpation and femoral artery pulse wave doppler for detection of SBP ≥60mmHg were calculated. Results: A total of 51 patients and 183 pulse checks were analyzed. There was a strong correlation between arterial line SBP and maximum waveform velocity (Spearman correlation coefficient: 0.92; p<0.001). The optimal cutoff value of waveform velocity associated with a SBP ≥60mmHG was 20 cm/second (Sn: 0.89; specificity: 0.94; area under the curve: 0.98) with an Acc of 0.92. To detect SBP ≥60mmHg, manual palpation had a Sn of 0.45, Sp of 0.82, and Acc of 0.67 McNemar's test showed that Sn (p<0.001), Sp (p=0.009), and Acc (p<0.001) was significantly higher for doppler ultrasound >=20cm/sec compared with manual palpation. Conclusion: In this study, during a pulse check, patients with a femoral arterial doppler waveform with a maximum velocity greater than 20cm/sec had a high probability of having a SBP ≥60mmHg, and improved Sn, Sp and Acc over manual palpation. The results demonstrate femoral arterial doppler maximum velocity is an accurate and objective tool to determine the presence of a pulse with adequate perfusion pressures.

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