1
|
Sonmez E, Taslidere B, Ozkan A. A new method of pulse control in cardiopulmonary resuscitation; Continuous femoral pulse check. Am J Emerg Med 2024; 80:168-173. [PMID: 38613985 DOI: 10.1016/j.ajem.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/08/2024] [Accepted: 03/16/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES The reliability of manual pulse checks has been questioned but is still recommended in cardiopulmonary resuscitation (CPR) guidelines. The aim is to compare the 10-s carotid pulse check (CPC) between heart massage cycles with the continuous femoral pulse check (CoFe PuC) in CPR, and to propose a better location to shorten the interruption times for pulse check. METHODS A prospective study was conducted on 117 Non-traumatic CPR patients between January 2020 and January 2022. A total of 702 dependent pulse measurements were executed, where carotid and femoral pulses were simultaneously assessed. Cardiac ultrasound, end-tidal CO2, saturation, respiration, and blood pressure were employed for pulse validation. RESULTS The decision time for determining the presence of a pulse in the last cycle of CPR was 3.03 ± 1.26 s for CoFe PuC, significantly shorter than the 10.31 ± 5.24 s for CPC. CoFe PuC predicted the absence of pulse with 74% sensitivity and 88% specificity, while CPC predicted the absence of pulse with 91% sensitivity and 61% specificity. CONCLUSION CoFe PuC provides much earlier and more effective information about the pulse than CPC. This shortens the interruption times in CPR. CoFe PuC should be recommended as a new and useful method in CPR guidelines.
Collapse
Affiliation(s)
- E Sonmez
- Kütahya Health Sciences University, Medical School, Department of Emergency Medicine, Kütahya, Turkey
| | - B Taslidere
- Bezmialem Vakif University Medical Faculty, Department of Emergency Medicine, İstanbul, Turkey
| | - A Ozkan
- Bağcılar Training And Research Hospital, Department of Emergency Medicine, İstanbul, Turkey.
| |
Collapse
|
2
|
da Costa FA, Mala-Ladova K, Lee V, Tous S, Papastergiou J, Griffiths D, Chaumais MC, Hersberger KE, Viola R, Paulino E, Lobban T, Neubeck L, Freedman B, Antoniou S. Awareness campaigns of atrial fibrillation as an opportunity for early detection by pharmacists: an international cross-sectional study. J Thromb Thrombolysis 2021; 49:606-617. [PMID: 31782043 DOI: 10.1007/s11239-019-02000-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation (AF) accounts for up to one third of strokes, one of the lead mortality causes worldwide. The European Society of Cardiology guidelines recommend opportunistic screening as a means to increase the odds of early detection and institution of appropriate treatment according to risk factors identified. However, in most countries there are various barriers to effective uptake of screening, including low awareness. The Atrial Fibrillation Association is a patient association engaged with raising awareness of AF. Establishing a partnership with the International Pharmacists for Anticoagulation Care Taskforce, we set as goals to test a model for raising awareness of AF involving pharmacists globally; and to identify barriers and enablers to its implementation. A cross-sectional study was conducted during the Arrhythmia Alliance World Heart Rhythm Week. Pharmacists from 10 countries invited individuals (≥ 40 years; without anticoagulation therapy of AF) to participate in the awareness campaign. Participants agreeing were engaged in the early detection of AF (EDAF) using pulse palpation. Individuals with rhythm discrepancies were referred and prospectively assessed to have information on the proportion of confirmed diagnosis, leading to estimate the detection rate. Interviews with country coordinators explored barriers and enablers to implementation. The study involved 4193 participants in the awareness campaign and 2762 in the EDAF event (mean age 65.3 ± 13.0), of whom 46.2% individuals were asymptomatic, recruited across 120 sites. Most common CHA2DS2-VASc risk factor was hypertension. Among 161 patients referred to physician, feedback was obtained for 32 cases, of whom 12 new arrhythmia diagnoses were confirmed (5 for AF, 2 for atrial flutter), all among elders (≥ 65 years). Qualitative evaluation suggested a local champion to enable pharmacists' success; technology enhanced engagement amongst patients and increased pharmacists' confidence in referring to physicians; interprofessional relationship was crucial in success. This study suggests pharmacists can contribute to greater outreach of awareness campaigns. Effective communication pathways for inter-professional collaboration were suggested enablers to gain full benefits of EDAF.
Collapse
Affiliation(s)
- Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-511, Caparica, Portugal. .,Faculdade de Farmácia, The Research Institute for Medicines (iMED.ULisboa), Universidade de Lisboa, Lisbon, Portugal.
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Akademika Heyrovského, 1203/8, 500 05, Hradec Kralove, Czech Republic
| | - Vivian Lee
- Centre for Learning Enhancement and Research, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Salvador Tous
- Sociedad Española de Farmacia Familiar y Comunitaria SEFAC, Travessera de Gràcia, 56, 08006, Barcelona, Spain
| | - John Papastergiou
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada
| | - Dale Griffiths
- Westview Pharmacy, 5 Glendale Road, Glen Eden, Auckland, 0602, New Zealand
| | - Marie-Camille Chaumais
- Faculté de Pharmacie, Hôpital Antoine Béclère, Université Paris-Sud, 157, Rue de la Porte de Trivaux, 92140, Clamart, France
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, University of Basel, Pharmazentrum, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Reka Viola
- Faculty of Pharmacy, University of Szeged, Zrínyi u. 9, Szeged, 6720, Hungary
| | - Ema Paulino
- Farmácia Nuno Álvares, Avenida D. Nuno Álvares Pereira, 39-C, Almada, Portugal
| | - Trudie Lobban
- Atrial Fibrillation Association (AF Assoc)/ Arrhythmia Alliance (A-A), AF Association, Unit 6B, Essex House, Cromwell Business Park, Chipping Norton, Oxfordshire, OX7 5SR, UK
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Sighthil Campus, Sighthill Court, Edinburgh, EH11 4BN, Scotland, UK
| | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, University of Sydney, John Hopkins Dr, Camperdown NSW, Sydney, 2006, Australia
| | - Sotiris Antoniou
- Barts Health NHS Trust, UCL Partners, 9 Prescot Street Aldgate, London, E1 8PR, UK
| |
Collapse
|
3
|
Yılmaz G, Bol O. Comparison of femoral and carotid arteries in terms of pulse check in cardiopulmonary resuscitation: A prospective observational study. Resuscitation 2021; 162:56-62. [PMID: 33582255 DOI: 10.1016/j.resuscitation.2021.01.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is no gold standard pulse localisation for pulse check in cardiopulmonary resuscitation. AIM To compare the femoral and carotid arteries in terms of pulse check in cardiopulmonary resuscitation and recommend the most appropriate pulse localisation in advanced life support guidelines and cardiopulmonary resuscitation training programmes. MATERIALS AND METHODS We prospectively conducted the study with patients who developed non-traumatic cardiopulmonary arrest between September 2018 and March 2019. The pulse check team was established and divided into two groups, A and B. Both carotid and femoral arteries were checked simultaneously for pulse by members of groups A and B, with the groups alternating between sites to avoid bias. We used some criteria to make pulse detection more effective. These were ETCO2, rhythm and cardiac ultrasonography. RESULTS We evaluated 1289 pulse checks in 102 patients. As a result of the statistical analysis with manual palpations and pulses criteria, which we used to detected the presence of a pulse in CPR, we found that the sensitivity of the carotid artery was significantly higher than that of the femoral artery (p = 0.017), with almost identical specificities. CONCLUSION The carotid artery should be recommended as the gold standard localisation for pulse checks in cardiopulmonary resuscitation in CPR training programmes and ACLS guidelines.
Collapse
Affiliation(s)
- Gökhan Yılmaz
- Department of Emergency Medicine, Kayseri City Hospital, Kayseri, Turkey.
| | - Oğuzhan Bol
- Department of Emergency Medicine, Kayseri City Hospital, Kayseri, Turkey
| |
Collapse
|
4
|
Smith DJ, Simard R, Chenkin J. Checking the pulse in the 21st century: Interobserver reliability of carotid pulse detection by point-of-care ultrasound. Am J Emerg Med 2020; 45:280-283. [PMID: 33046297 DOI: 10.1016/j.ajem.2020.08.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Detection of a pulse is crucial to decision-making in the care of patients who are in cardiac arrest, however, the current standard of manual pulse palpation is unreliable. An emerging alternative is the use of point-of-care ultrasound (POCUS) for direct assessment of the carotid pulse. The primary objective of this study is to determine the interobserver reliability for physician interpretation of pre-recorded point-of-care ultrasound pulse-check clips for patients who are in cardiac arrest. METHODS We conducted a web-based survey of residents and physicians working in an academic center. Participants were shown a tutorial demonstrating POCUS detection of the carotid pulse and then asked to interpret 15 carotid pulse ultrasound clips from patients who were in cardiac arrest. The primary outcome was interobserver reliability for carotid pulse assessment. Secondary outcomes included interobserver reliability stratified by physician role and POCUS experience, median tutorial and median pulse assessment duration. Interobserver reliability was determined by Krippendorff's ⍺. RESULTS 68 participants completed the study, with a response rate of 75%. There was high interobserver reliability for pulse assessment amongst all study participants (⍺ = 0.874, 95% CI 0.869 to 0.879). All sub-groups had ⍺ greater than 0.8. Median tutorial duration was 35 s (IQR 29). Median pulse assessment duration was 6 s (IQR 5) with 76% of assessments completed within 10 s. CONCLUSION Interpretation of the carotid pulse by POCUS showed high interobserver reliability. Further work must be done to determine the performance of POCUS pulse assessment in real-time for patients who are in cardiac arrest.
Collapse
Affiliation(s)
- David J Smith
- Division of Emergency Medicine, University of Toronto, C. David Naylor Building, 3rd Floor 6 Queen's Park Crescent West, Toronto, ON M5S 3H2, Canada.
| | - Robert Simard
- Division of Emergency Medicine, University of Toronto, C. David Naylor Building, 3rd Floor 6 Queen's Park Crescent West, Toronto, ON M5S 3H2, Canada; Department of Emergency Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, AG245, Toronto, ON M4N 3M5, Canada
| | - Jordan Chenkin
- Division of Emergency Medicine, University of Toronto, C. David Naylor Building, 3rd Floor 6 Queen's Park Crescent West, Toronto, ON M5S 3H2, Canada; Department of Emergency Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, AG245, Toronto, ON M4N 3M5, Canada
| |
Collapse
|
5
|
Sanchez S, Miller M, Asha S. Assessing the validity of two-dimensional carotid ultrasound to detect the presence and absence of a pulse. Resuscitation 2020; 157:67-73. [PMID: 33058995 DOI: 10.1016/j.resuscitation.2020.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/08/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Traditional assessment of return of cardiac output in cardiac arrest by manual palpation has poor accuracy. Point of care ultrasound of a major artery has been suggested as an alternative. We conducted a diagnostic accuracy study of two-dimensional carotid ultrasound to detect the presence or absence of a pulse, using cardiopulmonary bypass patients for pulse and pulseless states. METHODS A cross-sectional multi-patient, multi-reader repeated measures diagnostic study was conducted. For patients undergoing routine cardiopulmonary bypass, a portable ultrasound was used to record four 10-s videos the common carotid artery, three aimed for a pulse in high (>90 mmHg), medium (70-90 mmHg) and low (<70 mmHg) systolic blood pressure (SBP) ranges, and a pulseless video was recorded on cardiopulmonary bypass. Critical care physicians viewed the videos and were asked to nominate within 10 s if a pulse was present. True pulse-status was determined via the arterial-line waveform. RESULTS Twenty-three patients had all four videos collected. Median patient age was 64 (IQR 14), sixteen were male (70%) and median BMI was 27. The median SBP in high-, medium- and low-SBP groups were 120 mmHg, 83 mmHg and 69 mmHg respectively. Forty-six physicians reviewed a subset of 24 videos. Overall sensitivity was 0.91 (95% confidence interval 0.89-0.93) and specificity 0.90 (95% CI 0.86-0.93). Sensitivity was highest in the high-SBP group (0.96, 95% CI 0.93-0.98) and lowest in the low-SBP group (0.83, 95% CI 0.78-0.87). CONCLUSION 2D ultrasound of the common carotid artery is both sensitive and specific for detection of the presence or absence of a pulse.
Collapse
|
6
|
Badra K, Coutin A, Simard R, Pinto R, Lee JS, Chenkin J. 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 DOI: 10.1016/j.resuscitation.2019.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/16/2019] [Accepted: 03/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Manual pulse checks (MP) are an unreliable skill even in the hands of healthcare providers (HCPs). In the context of cardiac arrest, this may translate into inappropriate chest compressions when a pulse is present, or conversely omitting chest compressions when one is absent. To date, no study has assessed the use of B-mode ultrasound (US) for the detection of a carotid pulse. The primary objective of this study was to assess the time required to detect a carotid pulse in live subjects using US compared to the traditional palpation method. METHODS We conducted a prospective randomized controlled crossover non-inferiority trial. HCPs attended a 15 minute focused US workshop on identification of the carotid pulse. Both pulse check methods were timed for each participant on two different subjects in random order. The primary outcome was time to carotid pulse detection in seconds (s). Secondary outcomes included confidence levels of pulse detection measured on a 100 mm visual analog scale (VAS) and rates of prolonged pulse checks (> 5 s or >10 s). The study was powered to determine whether US pulse checks were not slower than MP by greater than two seconds. The results are presented as the difference in means with a 90% two-sided confidence interval (CI). RESULTS 111 participants completed the study. Mean pulse detection times were 4.22 s (SD 3.26) by US compared to 4.71 s (SD 6.45) by MP with a mean difference in times of -0.49 s (90% CI: -1.77 to 0.39). There were no significant differences between US and MP in the rates of prolonged pulse checks of greater than 5 s (23% vs 19%, p = 0.45) or 10 s (9% vs 8%, p = 0.81). First attempt at detection of pulse checks was more successful in the US group (99.1% vs 85.6%, p = 0.0001). Prior to training, participants reported higher confidence using MP compared to US; 68 (IQR 48-83) vs 15 (IQR 8-42) mm (p < 0.001). Following the study, participants reported higher confidence levels using US than MP; 91 (IQR 82-97) vs 83 (IQR 72-94) mm (p < 0.001). CONCLUSIONS Carotid pulse detection in live subjects was not slower using US as compared to palpation, and demonstrated higher first attempt success rate and less variability in measurement times. A brief teaching session was sufficient to improve confidence of carotid pulse identification even in those with no previous US training. The preliminary results from this study provide the groundwork for larger studies to evaluate this pulse check method for patients in cardiac arrest.
Collapse
Affiliation(s)
- Karine Badra
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
| | | | - Robert Simard
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jacques S Lee
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jordan Chenkin
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Zengin S, Gümüşboğa H, Sabak M, Eren ŞH, Altunbas G, Al B. Comparison of manual pulse palpation, cardiac ultrasonography and Doppler ultrasonography to check the pulse in cardiopulmonary arrest patients. Resuscitation 2018; 133:59-64. [PMID: 30253230 DOI: 10.1016/j.resuscitation.2018.09.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/24/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE For health professionals, the absence of pulse checked by manual palpation is a primary indicator for initiating chest compressions in patients considered to have cardiopulmonary arrest (CA). However, using a pulse check to evaluate perfusion during CA may be associated with some risks of its own. Our objective was to compare the efficiency of cardiac ultrasonography (CUSG), Doppler ultrasonography (DUSG), and manual pulse palpation methods to check the pulse in CA patients. MATERIAL AND METHODS This study was prospectively performed in 137 patients older than 16 years of age who underwent cardiopulmonary resuscitation (CPR). CUSG, DUSG, and manual pulse palpation were practiced simultaneously as suggested in the relevant guidelines. Findings of the patients were recorded at the first min, at min 15 and at the end of CPR. SPSS 18.0 was used for statistical analysis. FINDINGS A total of 72.3% (n = 99) of the cardiopulmonary arrest incidents occurred out-of-hospital. CUSG (4.76 ± 2.19, 4.33 ± 2.17, and 3.68 ± 2.14 s), DUSG (9.59 ± 2.37, 8.22 ± 2.86, and 7.60 ± 2.83 s), and manual pulse palpation (10.76 ± 1.03, 9.72 ± 3.01, and 9.29 ± 3.36 s) measurements of the first, second, and last inspections were detected, respectively. The false negative rates (100%, 28%, and 0%) and false positive rates (5.3%, 3.5%, and 0%) of manual pulse palpation the first, second, and last inspections were calculated, respectively, as well. CONCLUSION The use of real-time CUSG during resuscitation provides a substantial contribution to the resuscitation team. CUSG will allow earlier and more accurate detection of pulse than manual pulse palpation and DUSG.
Collapse
Affiliation(s)
- Suat Zengin
- Department of Emergency Medicine, Gaziantep University School of Medicine, Gaziantep, Turkey.
| | - Hasan Gümüşboğa
- Department of Emergency Medicine, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Mustafa Sabak
- Department of Emergency Medicine, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Şevki Hakan Eren
- Department of Emergency Medicine, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Gokhan Altunbas
- Department of Cardiology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Behçet Al
- Department of Emergency Medicine, Gaziantep University School of Medicine, Gaziantep, Turkey
| |
Collapse
|