Manual Palpation vs. Femoral Arterial Doppler Ultrasound for Comparison of Pulse Check Time During Cardiopulmonary Resuscitation in the Emergency Department: A Pilot Study

1.Why is this topic important? Manual palpation (MP) is the current gold standard employed for pulse checks during cardiopulmonary resuscitation (CPR), but studies have shown that trained medical personnel have difficulty accurately identifying pulselessness or return of spontaneous circulation (ROSC) using this technique.2.What does this study attempt to show? We explored whether femoral arterial Doppler ultrasound (FADU) decreases pulse check duration during CPR compared with MP among emergency medicine (EM) physicians who had received minimal additional didactic ultrasound (US) training.3.What are the key findings? The use of FADU was superior to MP in achieving shorter pulse check times by a median difference of 2 s. This 2-s reduction improved the median pulse check time to below the recommended pulse check threshold of 10 s according to the American Heart Association and European Resuscitation Council guidelines.4.How is patient care impacted? Preliminary research suggests FADU is more accurate than MP for confirming ROSC, but further research is needed to confirm the accuracy of FADU for identifying ROSC as well as to determine whether FADU can improve clinical outcomes. Manual palpation (MP) is frequently employed for pulse checks, but studies have shown that trained medical personnel have difficulty accurately identifying pulselessness or return of spontaneous circulation (ROSC) using MP. Any delays in identifying pulselessness can lead to significant delays in starting or resuming high-quality chest compressions. This study explored whether femoral arterial Doppler ultrasound (FADU) decreases pulse check duration during cardiopulmonary resuscitation (CPR) compared with MP among patients in the emergency department (ED) receiving CPR directed by emergency medicine physicians who had received minimal additional didactic ultrasound training. We performed a prospective observational cohort study from October 2018 to May 2019 at an urban community ED. Using convenience sampling, we enrolled patients arriving at our ED or who decompensated during their ED stay and received CPR. For continuous data, median (interquartile range [IQR]) were calculated, and medians were compared using Kruskal–Wallis test. Fifty-two eligible patients were enrolled and 135 pulse checks via MP and 35 via FADU were recorded. MP observations had a median (IQR) of 11.00 (7.36–15.48) s, whereas FADU had a median (IQR) of 8.98 (5.45–13.85) s. There was a difference between the two