Point-of-Care Ultrasound Compression of the Carotid Artery for Pulse Determination in Cardiopulmonary Resuscitation
31 Pages Posted: 18 May 2022
Abstract
Aim: To identify whether a novel pulse check technique, carotid artery compression using an ultrasound probe, can reduce pulse check times compared to manual palpation (MP).
Methods: This prospective study was conducted in an emergency department between February and December 2021. Point-of-care ultrasound–carotid artery compression (POCUS-CAC) was applied every 30 seconds, and carotid artery compressibility and pulsatility were assessed by probe compression. Another clinician performed MP of the femoral artery every 2 min. The primary outcome was the difference in the average time for pulse assessment between POCUS-CAC and MP. The secondary outcomes included the time difference in each pulse check between methods, the proportion of times greater than 5 s and 10 s, and the prediction of return of spontaneous circulation (ROSC) during ongoing chest compression.
Results: 25 cardiac arrest patients and 155 pulse checks were analyzed. The median (interquartile range) average time to carotid pulse identification per patient using POCUS-CAC was 1.62 (1.14–2.14) s compared to 3.50 (2.99–4.99) s with MP. In all 155 pulse checks, the POCUS-CAC time to determine ROSC was 0.44 times faster than the MP time (P < 0.001). The POCUS-CAC approach never exceeded 10 s, and the number of patients who required more than 5 s was significantly lower (5 vs . 37, P < 0.001). Under continuous chest compression, six pulse checks predicted the ROSC.
Conclusions: We found that emergency physicians could quickly determine pulses by applying simple POCUS compression of the carotid artery in cardiac arrest patients.
Note:
Clinical Trial Registration Details: Registered at ClinicalTrial.gov (ID NCT04793386).
Funding Information: No financial disclosures were reported by the authors of this paper.
Declaration of Interests: No potential conflicts of interest relevant to this article was reported.
Ethics Approval Statement: This single-center prospective study was conducted in the emergency department (ED) of a tertiary academic medical center with an annual volume of 70,000 patients in South Korea from February 2021 to December 2021. This study was approved by the Samsung Medical Center Institutional Review Board as a consent waiver (IRB file number 2020-11-116-002).
Keywords: Cpr, Point-of-care Ultrasound, POCUS, carotid artery, pulse check, palpation
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