Abstract 128: Time for a Change: Use of Doppler Ultrasound for Pulse Checks in Cardiac Arrest Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Allison Cohen ◽  
Timmy Li ◽  
Lance B Becker ◽  
Daniel Rolston ◽  
Mathew Nelson ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Sensitivity And Specificity ◽  
Doppler Ultrasound ◽  
Life Support ◽  
Arterial Line ◽  
Pulse Detection ◽  
Pulse Palpation ◽  
Manual Palpation ◽  
Sensitivity Specificity ◽  
Pulse Check

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.

scholarly journals 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 ◽  
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.

scholarly journals 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 ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023627 ◽  
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.

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

Circulation ◽  
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.

scholarly journals Transcutaneous Oxygen Saturation Accuracy in Critically Ill Children

2020 ◽  
Author(s):  
Joshua Cushing Brooks ◽  
Sainath Raman ◽  
Kristen Gibbons ◽  
Tara Williams ◽  
Kimble Robert Dunster ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
High Sensitivity ◽  
Critically Ill Children ◽  
Arterial Line ◽  
Transcutaneous Oxygen ◽  
Transcutaneous Oxygen Saturation ◽  
Sensitivity Specificity ◽  
Kappa Agreement

Abstract Background Pulse oximetry (SpO 2 ) is used to monitor oxygen saturation levels to avoid hypoxaemia in children. Sensor manufacturers claim high sensitivity, specificity and accuracy. Few studies have evaluated accuracy and precision of SpO 2 in children. Methods This prospective, observational study was conducted in a 36-bed mixed medical/surgical paediatric intensive care unit. All children <16 years old with an arterial line were eligible. Paired SpO 2 readings obtained with a Masimo and a Nellcor sensor were prospectively matched and validated to the arterial haemoglobin oxygen saturation (SaO 2 ). Bias between SpO 2 and SaO 2 (SpO 2 -SaO 2 ), accuracy root mean square (A rms ), sensitivity, specificity and kappa agreement were calculated for sensors. Multivariable regression analysis was conducted to determine the relationship between clinical variables and bias in paired sensor readings. Findings There were 929 participants with 16,839 readings (9,382 simultaneous Masimo and Nellcor). Nineteen percent of paired values had SaO 2 <88%. Bias increased with decreasing SaO 2 . Both sensors failed to achieve FDA’s A rms requirement in all ranges. Of the 15.5% patients with ‘true hypoxaemia’ (SaO 2 <88%), 28.6% (n=1165) were not correctly identified by pulse oximetry. Variables associated with higher odds of bias included sepsis, respiratory distress and post-cardiac arrest; increasing lactate; vasoconstrictor use; lower SaO 2 and low admission weight. Interpretation Both tested sensors, with current algorithms, are not precise enough for a PICU setting. Sensor readings in patients with respiratory disease, sepsis and cardiac arrest should be used with caution.

scholarly journals Effects of a Clinical Simulation Course about Basic Life Support on Undergraduate Nursing Students’ Learning

2021 ◽  
Vol 18 (4) ◽  
pp. 1409
Author(s):  
María del Mar Requena-Mullor ◽  
Raquel Alarcón-Rodríguez ◽  
María Isabel Ventura-Miranda ◽  
Jessica García-González
Keyword(s):  
Cardiac Arrest ◽  
Nursing Students ◽  
Learning Outcomes ◽  
Basic Life Support ◽  
Life Support ◽  
Undergraduate Nursing Students ◽  
Assessment Protocol ◽  
Clinical Simulation ◽  
Undergraduate Nursing ◽  
Post Test

Training in basic life support (BLS) using clinical simulation improves compression rates and the development of cardiopulmonary resuscitation (CPR) skills. This study analyzed the learning outcomes of undergraduate nursing students taking a BLS clinical simulation course. A total of 479 nursing students participated. A pre-test and post-test were carried out to evaluate theoretical knowledge of BLS through questions about anatomical physiology, cardiac arrest, the chain of survival, and CPR. A checklist was used in the simulation to evaluate practical skills of basic CPR. The learning outcomes showed statistically significant differences in the total score of the pre-test and after completing the BLS clinical simulation course (pre-test: 12.61 (2.30), post-test: 15.60 (2.06), p < 0.001). A significant increase in the mean scores was observed after completing the course in each of the four parts of the assessment protocol (p < 0.001). The increase in scores in the cardiac arrest and CPR sections were relevant (Rosenthal’s r: −0.72). The students who had prior knowledge of BLS scored higher on both the pre-test and the post-test. The BLS simulation course was an effective method of teaching and learning BLS skills.

scholarly journals Diagnostic characteristics of 11 formulae for calculating corrected flow time as measured by a wearable Doppler patch

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Jon-Émile S. Kenny ◽  
Igor Barjaktarevic ◽  
David C. Mackenzie ◽  
Andrew M. Eibl ◽  
Matthew Parrotta ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Sensitivity And Specificity ◽  
Doppler Ultrasound ◽  
Flow Time ◽  
Cardiac Preload ◽  
Respiratory Cycle ◽  
Quiet Breathing ◽  
Diagnostic Characteristics ◽  
Corrected Flow Time ◽  
Corrected Flow

Abstract Background Change of the corrected flow time (Ftc) is a surrogate for tracking stroke volume (SV) in the intensive care unit. Multiple Ftc equations have been proposed; many have not had their diagnostic characteristics for detecting SV change reported. Further, little is known about the inherent Ftc variability induced by the respiratory cycle. Materials and methods Using a wearable Doppler ultrasound patch, we studied the clinical performance of 11 Ftc equations to detect a 10% change in SV measured by non-invasive pulse contour analysis; 26 healthy volunteers performed a standardized cardiac preload modifying maneuver. Results One hundred changes in cardiac preload and 3890 carotid beats were analyzed. Most of the 11 Ftc equations studied had similar diagnostic attributes. Wodeys’ and Chambers’ formulae had identical results; a 2% change in Ftc detected a 10% change in SV with a sensitivity and specificity of 96% and 93%, respectively. Similarly, a 3% change in Ftc calculated by Bazett’s formula displayed a sensitivity and specificity of 91% and 93%. FtcWodey had 100% concordance and an R2 of 0.75 with change in SV; these values were 99%, 0.76 and 98%, 0.71 for FtcChambers and FtcBazetts, respectively. As an exploratory analysis, we studied 3335 carotid beats for the dispersion of Ftc during quiet breathing using the equations of Wodey and Bazett. The coefficient of variation of Ftc during quiet breathing for these formulae were 0.06 and 0.07, respectively. Conclusions Most of the 11 different equations used to calculate carotid artery Ftc from a wearable Doppler ultrasound patch had similar thresholds and abilities to detect SV change in healthy volunteers. Variation in Ftc induced by the respiratory cycle is important; measuring a clinically significant change in Ftc with statistical confidence requires a large sample of beats.

Improving the Appropriateness of Advanced Life Support Teams’ Dispatch: A Before-After Study

2021 ◽  
pp. 1-7
Author(s):  
Lorenzo Gamberini ◽  
Cosimo Picoco ◽  
Donatella Del Giudice ◽  
Corrado Zenesini ◽  
Marco Tartaglione ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Life Support ◽  
Advanced Life Support ◽  
Emergency Operation ◽  
Support Teams ◽  
Global Sensitivity ◽  
Emergency Logistics ◽  
Prehospital Emergency ◽  
Task Time ◽  
Algorithm Implementation

Abstract Background and Importance: The dispatch of Advanced Life Support (ALS) teams in Emergency Medical Services (EMS) is still a hardly studied aspect of prehospital emergency logistics. In 2015, the dispatch algorithm of Emilia Est Emergency Operation Centre (EE-EOC) was implemented and the dispatch of ALS teams was changed from primary to secondary based on triage of dispatched vehicles for high-priority interventions when teams with Immediate Life Support (ILS) skills were dispatched. Objectives: This study aimed to evaluate the effects on the appropriateness of ALS teams’ intervention and their employment time, and to compare sensitivity and specificity of the algorithm implementation. Design: This was a retrospective before-after observational study. Settings and Participants: Primary dispatches managed by EE-EOC involving ambulances and/or ALS teams were included. Two groups were created on the basis of the years of intervention (2013-2014 versus 2017-2018). Intervention: A switch from primary to secondary dispatch of ALS teams in case of high-priority dispatches managed by ILS teams was implemented. Outcomes: Appropriateness of ALS team intervention, total task time of ALS vehicles, and sensitivity and specificity of the algorithm were reviewed. Results: The study included 242,501 emergency calls that generated 56,567 red code dispatches. The new algorithm significantly increased global sensitivity and specificity of the system in terms of recognition of potential need of ALS intervention and the specificity of primary ALS dispatch. The appropriateness of ALS intervention was significantly increased; total tasking time per day for ALS and the number of critical dispatches without ALS available were reduced. Conclusion: The revision of the dispatch criteria and the extension of the two-tiered dispatch for ALS teams significantly increased the appropriateness of ALS intervention and reduced both the global tasking time and the number of high-priority dispatches without ALS teams available.

Validation of Michigan risk score and D-dimer to predict peripherally inserted central catheter-related thrombosis: A study of 206,132 catheter days

2021 ◽  
pp. 112972982110087
Author(s):  
Junren Kang ◽  
Wenyan Sun ◽  
Hailong Li ◽  
En ling Ma ◽  
Wei Chen
Keyword(s):  
Sensitivity And Specificity ◽  
Risk Score ◽  
Primary Objective ◽  
Class Iii ◽  
Operating Characteristics ◽  
Central Venous ◽  
Sensitivity Specificity ◽  
Catheter Related Thrombosis ◽  
D Dimer ◽  
Independent Cohort

Background: The Michigan Risk Score (MRS) was the only predicted score for peripherally inserted central venous catheters (PICC) associated upper extremity venous thrombosis (UEVT). Age-adjusted D-dimer increased the efficiency for UEVT. There were no external validations in an independent cohort. Method: A retrospective study of adult patients with PICC insertion was performed. The primary objective was to evaluate the performance of the MRS and age-adjusted D-dimer in estimating risk of PICC-related symptomatic UEVT. The sensitivity, specificity and areas under the receiver operating characteristics (ROC) of MRS and age-adjusted D-dimer were calculated. Results: Two thousand one hundred sixty-three patients were included for a total of 206,132 catheter days. Fifty-six (2.6%) developed PICC-UEVT. The incidences of PICC-UEVT were 4.9% for class I, 7.5% for class II, 2.2% for class III, 0% for class IV of MRS ( p = 0.011). The incidences of PICC-UEVT were 4.5% for D-dimer above the age-adjusted threshold and 1.5% for below the threshold ( p = 0.001). The areas under ROC of MRS and age-adjusted D-dimer were 0.405 (95% confidence interval (CI) 0.303–0.508) and 0.639 (95% CI 0.547–0.731). The sensitivity and specificity of MRS were 0.82 (95% CI, 0.69–0.91), 0.09 (95% CI, 0.08–0.11), respectively. The sensitivity and specificity of age-adjusted D-dimer were 0.64 (95% CI, 0.46–0.79) and 0.64 (95% CI, 0.61–0.66), respectively. Conclusions: MRS and age-adjusted D-dimer have low accuracy to predict PICC-UEVT. Further studies are needed.

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