(O-A2) The Application of Point-of-care Ultrasound in Improving Cardiopulmonary Resuscitation

Objectives: To use point of care ultrasound during pulse check in cardiac arrest to evaluate return of spontaneous circulation (ROSC) of the carotid artery using B- mode. We hypothesize that ultrasound will be more sensitive and accurate in detecting ROSC faster with pulsatility of the carotid pulse than manual palpation.

Background: Pulse checks remain a critical component of the current Cardiopulmonary Resuscitation (CPR) algorithm. Medical providers identify ROSC by the manual palpation of a pulse or with an arterial line. In patients presenting to the emergency department in cardiopulmonary arrest, physicians rely on manual palpation of pulses for ROSC, as these patients do not generally have an arterial line. Manual palpation is considered the default method for pulse checks during CPR. Studies have shown that carotid ultrasound pulse checks have potential to be superior to manual palpation and it may be better than manual palpation in low flow states.

Methods: Patients who present to the emergency department who require cardiopulmonary resuscitation (CPR) will be enrolled into the study. During CPR, undergraduate research associates will be using a butterfly handheld ultrasound device to record the carotid artery. The research associates are trained to detect carotid pulsation using a task trainer. During pulse checks, the researcher will record ultrasound image videos and keep timing for the entire duration of the pulse checks based on manual palpation. We will keep track of whether the pulse check ended in manual palpation of a pulse or in resuming compressions. Data obtained via ultrasound will not be used to change the CPR algorithm in any way. On occasions where ROSC is achieved, we will compare how long it takes to identify a pulse based off manual palpation versus how long to identify a pulse check on the ultrasound. On review, we will determine if there were any instances where a pulse was seen on ultrasound but not palpated manually OR if there was a pulse palpated manually but not seen on ultrasound. We will survey nurses and physicians regarding their opinions on the usefulness of POCUS carotid artery pulse checks during CPR.

Results: At the time of writing, 0 patients have been enrolled into the study.

Conclusions: Using ultrasound to better detect carotid pulsatility during cardiac arrest could decrease inappropriate chest compressions when a pulse is present and reduce both patient and emergency department staff and resource burden if POCUS is more sensitive and accurately identifies ROSC compared to manual palpation. A notable difficulty of enrollment for this study may be the limited number of cardiac arrests and the undergraduate research coordinators level of experience. Through the adoption of ultrasound guided pulse checks in cardiac arrest, we hope to see a reduction in the risk of adverse effects from prolonged inappropriate cardiac arrest management.

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Funding (Optional): None