EMT's, paramedics, nurses, and doctors all frequently check a pulse during CPR in order to assess quality of compressions, but is the presence of a palpable pulse REALLY an indicator of high quality CPR?
Studies seem to indicate that a palpable femoral pulse during CPR is actually retrograde venous pulsations about 50% of the time (in other words, the clinician is palpating blood rushing back through the venous system, not actually arterial pulsations.) Likewise, carotid pulses during CPR can be an indicator of flow movement, but remember- it IS NOT necessarily an indicator of perfusion to the myocardium or brain. Studies have NOT shown that using pulse checks as an assessment of CPR quality has ANY value. The preferred way to monitor CPR quality is waveform capnography (ETCO2).
The next time a colleague mentions that a patient has a good pulse with CPR, remember that it is not necessarily an indicator of decent perfusion, or high quality CPR at all.
References:
http://circ.ahajournals.org/content/102/suppl_1/I-105.full
http://circ.ahajournals.org/content/122/18_suppl_3/S729.full
More about femoral pulses (with doppler videos) here: http://doccottlesdesk.blogspot.com/2014/12/femoral-pulse-during-cpr-arterial-or.html
Studies seem to indicate that a palpable femoral pulse during CPR is actually retrograde venous pulsations about 50% of the time (in other words, the clinician is palpating blood rushing back through the venous system, not actually arterial pulsations.) Likewise, carotid pulses during CPR can be an indicator of flow movement, but remember- it IS NOT necessarily an indicator of perfusion to the myocardium or brain. Studies have NOT shown that using pulse checks as an assessment of CPR quality has ANY value. The preferred way to monitor CPR quality is waveform capnography (ETCO2).
The next time a colleague mentions that a patient has a good pulse with CPR, remember that it is not necessarily an indicator of decent perfusion, or high quality CPR at all.
References:
http://circ.ahajournals.org/content/102/suppl_1/I-105.full
http://circ.ahajournals.org/content/122/18_suppl_3/S729.full
More about femoral pulses (with doppler videos) here: http://doccottlesdesk.blogspot.com/2014/12/femoral-pulse-during-cpr-arterial-or.html
