Title: Carotid POCUS vs. Manual Pulse Check for Cardiac Arrest<br/>Author: Caleb Chan<br/><a href='http://umem.org/profiles/alumni/1583/'>[Click to email author]</a><hr/><p>
<strong><u><span style="color: rgb(0, 0, 0); font-family: Calibri, Arial, Helvetica, sans-serif; font-size: 13.3333px;">Point-of-care ultrasound compression of the carotid artery for pulse determination in cardiopulmonary resuscitation</span></u></strong></p>
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<strong style="color: rgb(0, 0, 0); font-family: Calibri, Arial, Helvetica, sans-serif; font-size: 10pt; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit;">Background:</strong></p>
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-shorter (and accurate) pulse/rhythm checks are better</div>
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-manual pulse checks are often not reliable and frequently exceed the recommended 10s window</div>
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-cardiac POCUS has been used as a possible adjunct but there have been concerns about interruptions in compressions </div>
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<strong>Study:</strong></div>
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-Single center, prospective, 25 patients with OHCA (155 pulse checks total)</div>
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-some exclusions: early cessation of CPR (49), "manpower shortage" (35)</div>
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-two physicians concurrently performing manual palpation (MP) of femoral artery and POCUS-carotid artery compression (POCUS-CAC) during pulse checks</div>
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-each with stopwatch to measure time to pulse judgment</div>
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-prev training with hour lecture and hands-on demonstration on how to assess/interpret the compressibility and pulsatility of the carotid artery</div>
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POCUS-CAC: </div>
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-linear probe placed transversely across patient’s middle neck to identify the carotid artery and internal jugular vein on the screen</div>
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-probe pressure was applied until the internal jugular vein was completely compressed</div>
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-absent pulse = lack of pulsation and complete compression of the carotid artery under probe pressure</div>
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-present pulse = any visual pulsation or incomplete compression of the carotid artery</div>
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<strong>Results:</strong></div>
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-the average time for carotid pulse identification per patient significantly different</div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;"> -</span>POCUS-CAC was 1.62 (1.14– 2.14) s </div>
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<span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; font-size: 10pt; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;"> -MP </span>3.50 (2.99–4.99) s</span></div>
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-in all 155 pulse checks, the time to complete a pulse check with POCUS-CAC never exceeded 10 s, whereas five cases with MP exceeded this.</div>
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<strong>Takeaways/caveats:</strong></div>
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-larger study is needed and focus should be on rhythm checks, but if staffing allows, can consider utilizing POCUS-CAC as an adjunct for pulse checks </div>
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-the MP time in this study is much shorter than in prev studies</div>
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-would be interesting to see if the findings would be even more exaggerated in a larger patient population (average BMI in the study was 23!)</div>
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-small sample, <span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; font-size: 10pt; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">did not address carotid stenosis/atherosclerosis, </span><span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; font-size: 10pt; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">no standardization for intensity of compression applied</span></div>
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<fieldset><legend>References</legend>
<p>
S. Y. Kang, I. J. Jo, G. Lee et al., Point-of-care ultrasound compression of the carotid artery for pulse determination in cardiopulmonary resuscitation, Resuscitation, https://doi.org/10.1016/j.resuscitation.2022.06.025</p>
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