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

Abstract

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.