UMEM Educational Pearls

Title: Carotid POCUS vs. Manual Pulse Check for Cardiac Arrest

Category: Critical Care

Posted: 9/13/2022 by Caleb Chan, MD
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Point-of-care ultrasound compression of the carotid artery for pulse determination in cardiopulmonary resuscitation

Background:

-shorter (and accurate) pulse/rhythm checks are better

-manual pulse checks are often not reliable and frequently exceed the recommended 10s window

-cardiac POCUS has been used as a possible adjunct but there have been concerns about interruptions in compressions

Study:

-Single center, prospective, 25 patients with OHCA (155 pulse checks total)

-some exclusions: early cessation of CPR (49), "manpower shortage" (35)

-two physicians concurrently performing manual palpation (MP) of femoral artery and POCUS-carotid artery compression (POCUS-CAC) during pulse checks

-each with stopwatch to measure time to pulse judgment

-prev training with hour lecture and hands-on demonstration on how to assess/interpret the compressibility and pulsatility of the carotid artery

POCUS-CAC:

-linear probe placed transversely across patient’s middle neck to identify the carotid artery and internal jugular vein on the screen

-probe pressure was applied until the internal jugular vein was completely compressed

-absent pulse = lack of pulsation and complete compression of the carotid artery under probe pressure

-present pulse = any visual pulsation or incomplete compression of the carotid artery

Results:

-the average time for carotid pulse identification per patient significantly different

-POCUS-CAC was 1.62 (1.14– 2.14) s

-MP 3.50 (2.99–4.99) s

-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.

Takeaways/caveats:

-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

-the MP time in this study is much shorter than in prev studies

-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!)

-small sample, did not address carotid stenosis/atherosclerosis, no standardization for intensity of compression applied

References

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