Comparison of manual palpation, 2D carotid ultrasound, and end-tidal carbon dioxide for detecting return of spontaneous circulation.

Abstract

Objective: Healthcare providers frequently spend excessive time attempting to identify a pulse and may have difficulty accurately confirming its presence. Point-of-care carotid artery ultrasonography has been suggested as a potential alternative to manual palpation. This study aimed to evaluate the effectiveness of manual palpation, 2D carotid ultrasonography, and rapid increases in end-tidal carbon dioxide (EtCO2) levels for determining the return of spontaneous circulation (ROSC) in patients with cardiac arrest presenting to an emergency department.

Methods: This was a single-center, prospective, observational study. Nontraumatic adult patients in cardiopulmonary arrest who were brought to the emergency department were included. After cardiac arrest was identified, the following data were recorded: initial arrest rhythm, ultrasonographic and manual pulse assessments, EtCO2 levels, resuscitation duration, and post-ROSC vital signs. The team leader's judgment was used for ROSC adjudication and served as the reference standard.

Results: The investigation included 88 patients who underwent a total of 642 cycles of cardiopulmonary resuscitation. The area under the curve (AUC) values for 2D carotid ultrasonography, EtCO2, and manual palpation were 0.974, 0.802, and 0.862, respectively (all P<0.001). In pairwise AUC comparisons, ultrasonography differed significantly from manual palpation (P=0.001) and EtCO2 (P<0.001), whereas manual palpation and EtCO2 did not differ significantly (P=0.167). Bedside ultrasonography for detecting a carotid pulse had a sensitivity of 93.8% and a specificity of 100%.

Conclusion: These findings suggest that 2D carotid ultrasonography can be effectively used to detect a pulse in patients with cardiopulmonary arrest.