Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest

• Published in: Resuscitation 2022-04, Vol.173, p.156-165
• Main Authors: Cohen, Allison L., Li, Timmy, Becker, Lance B., Owens, Casey, Singh, Neha, Gold, Allen, Nelson, Mathew J., Jafari, Daniel, Haddad, Ghania, Nello, Alexander V., Rolston, Daniel M., Sison, Cristina, Lesser, Martin L.
• Format: Article
• Language: English
• Subjects: Adult; Blood Flow Velocity; Cardiac arrest; Cardiopulmonary resuscitation; Cross-Sectional Studies; Doppler ultrasound; Femoral Artery - diagnostic imaging; Heart Arrest - diagnosis; Humans; Palpation; Prospective Studies; Pulse detection; Ultrasonography, Doppler
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2022.01.030

Our primary objective was to assess the accuracy of Doppler ultrasound versus manual palpation in detecting any pulse with an arterial line waveform in cardiac arrest. Secondarily, we sought to determine whether peak systolic velocity (PSV) on Doppler ultrasound could detect a pulse with a systolic blood pressure (SBP) ≥ 60 mmHg. We conducted a prospective, cross-sectional, diagnostic accuracy study on a convenience sample of adult, Emergency Department (ED) cardiac arrest patients. All patients had a femoral arterial line. During a pulse check, manual pulse detection, PSV and Doppler ultrasound clips, and SBP were recorded. A receiver operator characteristic curve analysis was performed to determine the optimal cut-off of PSV associated with a SBP ≥ 60 mmHg. Accuracy of manual palpation and Doppler ultrasound for detection of any pulse and SBP ≥ 60 mmHg were compared with McNemar’s test. 54 patients and 213 pulse checks were analysed. Doppler ultrasound demonstrated higher accuracy than manual palpation (95.3% vs. 54.0%; p