Comparison of Manual Pulse Palpation, Cardiac Ultrasonography and Doppler Ultrasonography to Check the Pulse in Cardiopulmonary Arrest Patients

Resuscitation. 2018 Dec;133:59-64. doi: 10.1016/j.resuscitation.2018.09.018. Epub 2018 Sep 22.


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.

Keywords: Cardiac ultrasonography; Cardiopulmonary arrest; Doppler ultrasonography; Pulse check.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiopulmonary Resuscitation / mortality
  • Female
  • Heart Rate*
  • Humans
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / mortality
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Palpation / adverse effects*
  • Palpation / statistics & numerical data
  • Predictive Value of Tests
  • Pulse / methods*
  • Time Factors
  • Ultrasonography / adverse effects*
  • Ultrasonography / methods
  • Ultrasonography / statistics & numerical data*