# Point-of-Care Ultrasound Pulse Checks During Cardiopulmonary Resuscitation on a Patient Simulator (PUPRAS)

## TL;DR

This study tests if ultrasound can be used to check for pulse during CPR, finding it faster and easier than traditional methods.

## Contribution

A novel POCUS pulse check algorithm was evaluated for feasibility and compliance with CPR guidelines during simulated resuscitation.

## Key findings

- POCUS pulse checks were faster than manual checks, with an average time of 6.1 seconds versus 7.3 seconds.
- Participants found POCUS pulse checks easy to perform (77%) and useful (94%).
- POCUS checks were performed at the femoral artery in 62% of cases and during the fourth rhythm analysis in 93% of cases.

## Abstract

Background/Objectives: During cardiopulmonary resuscitation (CPR), patients must be checked for signs of return of spontaneous circulation (ROSC). Point-of-care ultrasound (POCUS) may be more reliable for detecting the ROSC. We investigated whether a POCUS pulse check algorithm could be used in compliance with the CPR guidelines. Methods: This was a prospective controlled and blinded multicentre manikin study involving staff from two tertiary clinical centres and their emergency medical services. A standard operating procedure for POCUS pulse checks during CPR was evaluated using a simulator in a team of four. The POCUS pulse checks were performed at the central artery following basic and advanced life support. The first pulse check was performed in the setting of pulseless electrical activity, and the second was performed in the presence of ROSC. The participants also completed a questionnaire. Results: A total of 444 pulse checks (244 manual/200 POCUS) were performed in 100 scenarios. The participants comprised physicians (34%), nurses (15%), non-physician emergency medical services personnel (37%), and other medical personnel (14%). The pulse checks took an average of 6.7 s (SD 3.9 s). Manual pulse checks (7.3 s) took longer than ultrasound pulse checks (6.1 s; p < 0.01), which were performed after a mean of 7.1 min (SD 1.7 min), during the fourth rhythm analysis in 93% of cases, and at the femoral artery in 62% of cases. They were rated as “easy” to perform by 77% and “useful” by 94%. Conclusions: POCUS pulse checks basically seem easy to implement and appear to be feasible during CPR.