Demonstration of Doppler Ultrasound Pulse Detection by Trained Prehospital Personnel A Feasibility Study
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Abstract
Background and Aim: Data suggests that finger palpation of the carotid and/or femoral pulses is significantly less sensitive than 100%. In some cases, a patient who does, in fact, have organized cardiac function, may be identified as being in Pulseless Electrical Activity (PEA). Chest compressions performed as indicated by these circumstances may not provide significant therapeutic benefit to those patients and may, in fact, distract from better directed therapies. Doppler Ultrasonography (DUSG) has been shown to be more sensitive than human fingers. This research aims to assess whether EMT-Basics and Paramedics can be quickly and inexpensively trained to use DUSG as a tool for pulse detection.
Methods: Participants viewed a recorded video 4 minutes 18 seconds in length which detailed an anterior-to-posterior fanning technique for assessing presence of a carotid pulse using a doppler ultrasound device. The participants were given a short period of time to practice and familiarize themselves with the device. Participants were then timed while demonstrating application of ultrasound-conducting gel to a volunteer and using the device to detect a carotid pulse. The time recording ceased when the participant verbalized confirmation of the pulse, and their success or failure was annotated.
Results: Credentialed EMT-Basics and Paramedics, with minimal training, consistently demonstrated the ability to accurately and rapidly assess a carotid pulse using a doppler ultrasound device.
Conclusions: This research suggests that prehospital personnel can be efficiently trained to use available and inexpensive doppler ultrasound devices to determine cardiac pulse status. Furthermore, it suggests that the technique itself can be used to detect the carotid pulse quickly and accurately. Further research in patient care settings should be undertaken to evaluate the utility of doppler ultrasound devices in distinguishing PEA from Pseudo-PEA.
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References
Badra, K., Coutin, A., Simard, R., Pinto, R., Lee, J. S., & Chenkin, J. (2019). The POCUS pulse check: A randomized controlled crossover study comparing pulse detection by palpation versus by point-of-care ultrasound. Resuscitation, 139, 17–23. https://doi.org/10.1016/j.resuscitation.2019.03.009
Brearley, S., Shearman, C. P., & Simms, M. H. (1992). Peripheral pulse palpation: An unreliable physical sign. Annals of the Royal College of Surgeons of England, 74(3), 169–171.
Cheung, J. C., & Yip, Y. Y. (2021). Pseudo-PEA: An easily overlooked player in cardiac arrest. Resuscitation, 168, 240–241. https://doi.org/10.1016/j.resuscitation.2021.08.051
Cohen, A. L., Li, T., Becker, L. B., Owens, C., Singh, N., Gold, A., Nelson, M. J., Jafari, D., Haddad, G., Nello, A. V., Rolston, D. M., & Northwell Health Biostatistics Unit (2022). Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest. Resuscitation, 173, 156–165. https://doi.org/10.1016/j.resuscitation.2022.01.030
Faldaas, B. O., Nielsen, E. W., Storm, B. S., Lappegård, K. T., Nilsen, B. A., Kiss, G., Skogvoll, E., Torp, H., & Ingul, C. B. (2024). Real-time feedback on chest compression efficacy by hands-free carotid Doppler in a porcine model. Resuscitation Plus, 18, 100583. https://doi.org/10.1016/j.resplu.2024.100583
Gaspari, R. J., Lindsay, R., Dowd, A., & Gleeson, T. (2023). Femoral arterial Doppler use during active cardiopulmonary resuscitation. Annals of Emergency Medicine, 81(5), 523–531. https://doi.org/10.1016/j.annemergmed.2022.12.002
Kang, S. Y., Jo, I. J., Lee, G., Park, J. E., Kim, T., Lee, S. U., Hwang, S. Y., Shin, T. G., Kim, K., Shim, J. S., & Yoon, H. (2022). Point-of-care ultrasound compression of the carotid artery for pulse determination in cardiopulmonary resuscitation. Resuscitation, 179, 206–213. https://doi.org/10.1016/j.resuscitation.2022.06.025
Mather, C., & O'Kelly, S. (1996). The palpation of pulses. Anaesthesia, 51(2), 189–191. https://doi.org/10.1111/j.1365-2044.1996.tb07713.x
Oliver, T. I., Sadiq, U., & Grossman, S. A. (2023). Pulseless electrical activity. In StatPearls. StatPearls Publishing.
Özlü, S., Bilgin, S., Yamanoglu, A., Kayalı, A., Efgan, M. G., Çınaroğlu, O. S., & Tekyol, D. (2023). Comparison of carotid artery ultrasound and manual method for pulse check in cardiopulmonary resuscitation. The American Journal of Emergency Medicine, 70, 157–162. https://doi.org/10.1016/j.ajem.2023.05.045
Panchal, A. R., Bartos, J. A., Cabañas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., Kudenchuk, P. J., Kurz, M. C., Lavonas, E. J., Morley, P. T., O'Neil, B. J., Peberdy, M. A., Rittenberger, J. C., Rodriguez, A. J., Sawyer, K. N., Berg, K. M., & Adult Basic and Advanced Life Support Writing Group (2020). Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 142(16_suppl_2), S366–S468. https://doi.org/10.1161/CIR.0000000000000916
Rabjohns, J., Quan, T., Boniface, K., & Pourmand, A. (2020). Pseudo-pulseless electrical activity in the emergency department, an evidence-based approach. The American Journal of Emergency Medicine, 38(2), 371–375. https://doi.org/10.1016/j.ajem.2019.158503
Schwartz, B. E., Gandhi, P., Najafali, D., Gregory, M. M., Jacob, N., Helberg, T., Thomas, C., Lowie, B. J., Huis In 't Veld, M. A., & Cruz-Cano, R. (2021). Manual palpation vs. femoral arterial Doppler ultrasound for comparison of pulse check time during cardiopulmonary resuscitation in the emergency department: A pilot study. The Journal of Emergency Medicine, 61(6), 720–730. https://doi.org/10.1016/j.jemermed.2021.03.016
Smith, D. J., Simard, R., & Chenkin, J. (2021). Checking the pulse in the 21st century: Interobserver reliability of carotid pulse detection by point-of-care ultrasound. The American Journal of Emergency Medicine, 45, 280–283. https://doi.org/10.1016/j.ajem.2020.08.072
Smith, N., Lopez, R. A., & Silberman, M. (2023). Distributive shock. In StatPearls. StatPearls Publishing.
Tibballs, J., & Russell, P. (2009). Reliability of pulse palpation by healthcare personnel to diagnose paediatric cardiac arrest. Resuscitation, 80(1), 61–64. https://doi.org/10.1016/j.resuscitation.2008.10.002
Van den Bempt, S., Wauters, L., & Dewolf, P. (2021). Pulseless electrical activity: Detection of underlying causes in a prehospital setting. Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre, 30(3), 212–222. https://doi.org/10.1159/000513431
Yu, A. H., Cohen-Solal, E., Raju, B. I., & Ayati, S. (2008). An automated carotid pulse assessment approach using Doppler ultrasound. IEEE Transactions on Bio-Medical Engineering, 55(3), 1072–1081. https://doi.org/10.1109/TBME.2007.908104
Zengin, S., Gümüşboğa, H., Sabak, M., Eren, Ş. H., Altunbas, G., & Al, B. (2018). Comparison of manual pulse palpation, cardiac ultrasonography and Doppler ultrasonography to check the pulse in cardiopulmonary arrest patients. Resuscitation, 133, 59–64. https://doi.org/10.1016/j.resuscitation.2018.09.018