POCUS Pulse checks in cardiac arrest

The pulse check has been an important part of the assessment of unresponsive patients. It may be the determining factor in making the decision to commence CPR. We know that pulse checks are associated with both false positives and false negatives. False negatives can result in potentially unnecessary CPR being performed and false positives, can result in CPR being withheld... potentially disastrous. It is for this reason that we don't do pulse checks now, but commence CPR in the unresponsive patient.

There are some situations when knowing if there is a pulse, or cardiac output is important. The pulse determines the difference between PEA and a shocked state.

Here we review two important papers:

1. Tibballs J et al. The influence of time on the accuracy of healthcare personnel to diagnose paediatric cardiac arrest by pulse palpation. Resuscitation 2010;81; 671-675
2. Badra K et al The POCUS pulse check: A randomized controlled crossover study comparing pulse detection by palpation versus by point-of-care ultrasound. Resuscitation 2019;139:17-23. PMID: 30902687

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