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Heartbeat assessment in infants: a comparison of four clinical methods
Armando Sarti1, Fabio Savron, Veronica Casotto
1Department of Anaesthesia and Intensive Care, IRCCS Istituto per l'Infanzia Burlo Garofolo, Trieste, Italy.
Insights
Apex ear auscultation is the most effective method for detecting infant heartbeats, proving faster and more accurate than pulse palpation. Pulse checking remains vital for circulation assessment.
Area of Science:
- Pediatric Emergency Medicine
- Neonatal Care
- Clinical Assessment Techniques
Background:
- Accurate heart rate assessment is critical in pediatric emergencies.
- Current methods for infant heart rate detection include auscultation and pulse palpation.
- Evaluating the performance of these methods is essential for optimizing clinical practice.
Purpose of the Study:
- To compare the efficacy of four clinical methods for detecting and counting infant heartbeats.
- The methods evaluated were apex ear auscultation and brachial, carotid, and femoral pulse palpation.
Main Methods:
- A cross-sectional, repeated-measures study was conducted.
- Fifty-six sedated infants (1-12 months) were assessed by 14 pediatric basic life support (PBLS)-qualified professionals.
- Data were collected prospectively in a pediatric teaching hospital's postanesthesia care unit.
Main Results:
- Apex auscultation demonstrated the highest success rate (98%) for heartbeat detection.
- Apex auscultation was the most rapid (median 4 seconds) and accurate method (median discrepancy of 8 beats/min).
- Pulse palpation methods showed no significant differences in effectiveness among themselves.
Conclusions:
- Apex ear auscultation is the superior method for detecting and counting heartbeats in infants without instruments.
- Pulse palpation remains important for evaluating circulation, with brachial, carotid, and femoral pulses being equally effective.
- These findings support the use of apex auscultation as a primary method for heart rate assessment in pediatric basic life support.
Objective:
To compare the performance of four clinical methods (apex ear auscultation; brachial, carotid, and femoral pulse palpation) for detecting and counting heart beat in infants.
Design:
Cross-sectional, repeated-measures study design. Prospective data collection.
Setting:
A postanesthesia care unit of a pediatric teaching hospital in Italy.
Patients:
Fifty-six normotensive sedated infants, aged 1-12 mos, were evaluated by 14 pediatric basic life support (PBLS)-qualified health professionals.
Interventions:
None.
Measurements And Main Results:
The proportion of successful heartbeat detections ranged from 60% with carotid pulse palpation to 98% with apex auscultation. Among successful detections, apex auscultation proved to be the most rapid way to detect heart rate (median, 4 secs) and the most accurate with a median discrepancy of 8 beats/min (vs. 12 with the other methods) from the electrocardiographic results. Differences between apex auscultation and pulse palpation were statistically significant (p < .0001). In contrast, no significant differences were found among the three methods of pulse checking.
Conclusions:
Apex listening is the most successful, rapid, and accurate method to detect and count the heartbeat by PBLS-certified professionals in normotensive infants without instruments. Pulse checking remains important for assessing the effectiveness of circulation. Palpating the brachial, carotid, or femoral pulse is equally effective.
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