Ultrasound may aid in rapid and accurate pulse assessment in CPR situations, reveals research

Recent study involved testing medical students' ability to differentiate between 'pulsation present' and 'no pulsation present' using ultrasound videos of the common carotid artery (CCA) after watching a brief introductory video. The study aimed to assess the students' accuracy in determining the presence of a pulse using different ultrasound modes (B-mode, M-mode, and Color Doppler).

Results and Conclusions

A total of 432 medical students participated in the study, evaluating 8640 decisions on CCA pulse detection. The results showed high accuracy in identifying pulsatile CCA using M-mode (96%) and Color Doppler (99.5%). B-mode exhibited lower accuracy in detecting pulsation (69%) but was highly reliable in identifying the absence of pulsation (99%). The study concluded that medical students could effectively detect the absence of a pulse using 2D ultrasound of the CCA, suggesting that a combination of Color Doppler and B-mode could be practical during CPR scenarios.

Challenges and Implications

The study highlighted the challenges in manually palpating pulses during CPR and emphasized the importance of prompt pulse checks. It also discussed the potential role of ultrasound in quickly assessing pulsation, especially when dealing with scenarios like reduced contractility post-resuscitation. Differentiating between pseudo-pulseless electrical activity (PEA) and true PEA using TEE or TTE echocardiography was mentioned, with a focus on the practicality of assessing CCA pulsation as a surrogate parameter.

Ultrasound in Pulse Detection

The research findings suggested that a simple dichotomous question of 'CCA pulsation present' or 'no pulsation present' could be effectively answered using ultrasound by medical students, even with limited experience. Color Doppler exhibited the highest sensitivity, while B-mode showed the highest specificity in pulse detection. The study indicated the potential for ultrasound to aid in rapid and accurate pulse assessment in CPR situations.

Study Limitations

The limitations of the study included the controlled setting and the use of pre-recorded ultrasound videos, which may not fully simulate real-world conditions. The need for further clinical studies to validate the technique in actual CPR settings was highlighted. Overall, the study underscored the efficacy of ultrasound in assisting healthcare providers in assessing pulsation during CPR and suggested areas for future research in this field.

Key Points

- The study focused on assessing medical students' ability to differentiate between 'pulsation present' and 'no pulsation present' in the common carotid artery using ultrasound videos in various modes (B-mode, M-mode, and Color Doppler) after watching an introductory video.

- Results demonstrated high accuracy in identifying pulsatile common carotid artery using M-mode (96%) and Color Doppler (99.5%), with B-mode having lower accuracy in pulse detection (69%) but high reliability in identifying the absence of pulsation (99%).

- Medical students could effectively detect the absence of a pulse using 2D ultrasound of the common carotid artery, suggesting the practicality of utilizing a combination of Color Doppler and B-mode during CPR scenarios.

- Challenges in manually palpating pulses during CPR were noted, emphasizing the importance of prompt pulse checks. Ultrasound was discussed as a potential tool for quickly assessing pulsation, especially post-resuscitation scenarios with reduced contractility.

- Color Doppler showed the highest sensitivity, while B-mode exhibited the highest specificity in pulse detection, indicating the potential for ultrasound to aid in rapid and accurate pulse assessment in CPR situations.

- Study limitations included the controlled setting and the use of pre-recorded ultrasound videos, highlighting the need for further clinical studies to validate the technique in real CPR settings. The study emphasized the efficacy of ultrasound in assisting healthcare providers in pulse assessment during CPR and pointed out areas for future research in the field.

Reference –

B. Vojnar et al. (2024). Visual Detection Of Pulselessness By Carotid Artery Sonography - A Prospective Observational Study Among Medical Students.. *Resuscitation*, 110461 . https://doi.org/10.1016/j.resuscitation.2024.110461.