The use of Point of Care Ultrasound (POCUS) for pulse and cardiac assessment during CPR

This month, JC continues our deeper dive into cardiology topics. Since the beginning of the academic year, we looked at ED management of A-fib as well as the use of CCTA in ED chest pain patients both co-moderated by our amazing cardiology and radiology colleagues. This month, we will be looking at the use of POCUS during CPR in order to avoid misdiagnosing a potentially salvageable patient as being “dead” or having “pseudo-PEA”. It appears the digitometer, otherwise known as your finger, is not as accurate as you may like to believe when doing pulse checks during CPR. In fact, it generally can take longer than many are willing to admit, resulting in unacceptable pauses in CPR, which with defibrillation, are the only interventions with proven patient-centered outcome data. For those of us who did not grow up with POCUS, the idea of using US to help with basic pulse checks has been met with a few eye-rolls. “Next we’ll be using POCUS to confirm evidence of turbinate edema in runny noses.” Ok, so maybe that’s not a direct quote but, you get the idea. Our presenters will help review current data regarding effective use of POCUS for pulse or cardiac checks during CPR. Hopefully, our US gurus will provide us with some pragmatic advice on how to do it effectively and avoid seemingly ridiculous delays in CPR. Next month, we will close out our high value Cardiology topics for a bit with Dr Byars who has offered to moderate a JC update on the effective use of ECMO in the ED setting.

Sanchez S et al., Assessing the validity of two-dimensional carotid ultrasound to detect the presence and absence of a pulse. Resuscitation. 2020 Dec;157:67-73 Epub 2020 Oct 12. PMID: 33058995.

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 Jun;139:17-23. Epub 2019 Mar 20. PMID: 30902687. 

Wu C, et al., The predictive value of bedside ultrasound to restore spontaneous circulation in patients with pulseless electrical activity: A systematic review and meta-analysis. PLoS One. 2018 Jan 24;13(1) PMID: 29364925