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Updated: May 5, 2026
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Pulse check accuracy in pediatrics during resuscitation: a systematic review
Stephan Katzenschlager1, Jason Acworth2,3, Lokesh Kumar Tiwari4
1Heidelberg University, Medical Faculty Heidelberg, Department of Anaesthesiology, Heidelberg, Germany.
Insights
Manual pulse checks in children have moderate accuracy and take too long, suggesting they are unreliable for determining cardiac arrest and the need for cardiopulmonary resuscitation (CPR). Further research into diagnostic techniques is warranted.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Clinical Diagnostics
Background:
- Current guidelines recommend cardiopulmonary resuscitation (CPR) for unresponsive, non-breathing children.
- Manual pulse checks are often used but are considered unreliable and time-consuming in pediatric emergencies.
Purpose of the Study:
- To systematically review the accuracy and duration of manual pulse check methods in pediatric cardiac arrest.
- To explore emerging diagnostic techniques for assessing pediatric cardiac arrest.
Main Methods:
- A systematic review of three databases (PubMed, Embase, Cochrane) was conducted.
- Studies comparing manual pulse checks to alternative methods in pediatric patients were included.
- Evidence quality was assessed using QUADAS-2 and GRADE tools.
Main Results:
- Three studies involving 39 pediatric patients were analyzed.
- Manual pulse checks showed moderate accuracy (sensitivity 76-100%, specificity 64-79%) and a mean duration of 20 seconds.
- Experienced providers demonstrated slightly higher accuracy than inexperienced ones.
Conclusions:
- Manual pulse checks in children demonstrate moderate accuracy and prolonged duration, indicating unreliability for diagnosing cardiac arrest.
- These findings question the utility of manual pulse checks in pediatric cardiac arrest scenarios.
- There is a need for improved diagnostic methods for pediatric cardiac arrest determination.
Aim Of The Study:
Current guidelines advise rescuers to initiate cardiopulmonary resuscitation if a child is unresponsive, not breathing normally, and shows no signs of life. Manual pulse checks are considered unreliable and time-consuming. This systematic review evaluates the accuracy and duration of recommended pulse check methods during pediatric cardiac arrest and explores emerging diagnostic techniques.
Methods:
For this systematic review (PROSPERO ID CRD42024549535) three databases (PubMed, Embase, and Cochrane) were searched for articles published on this topic. An initial search was conducted on April 24, 2024, with an updated search using the same search strategy on February 16, 2025. Two authors independently screened the articles. One author extracted the data while a second author double-checked it. Quality and certainty of the evidence were evaluated using the QUADAS-2 and GRADE tools evaluated the evidence's quality and certainty. Studies were included if they compared manual pulse checks against alternative pulse check sites or other methods in pediatric patients. The data is presented descriptively.
Results:
A total of three studies were included. These studies involved 39 pediatric patients and a total of 376 pulse checks. Out of the 47 infants and children included, only 14 were in cardiac arrest. The remaining 33 patients were on mechanical circulatory support with either VA-ECMO or LVAD. In total, 183 nurses and 181 physicians performed 376 pulse or ultrasound checks. Due to their specialty, 122 nurses and 89 doctors were classified as experienced. Sensitivity and specificity of manual pulse check ranged from 76 to 100% and 64-79%, respectively. When experienced providers conducted pulse checks, sensitivity and specificity were higher (76-100% and 62-82%, respectively) compared to inexperienced providers (67-82% and 44-95%).The mean duration of pulse checks was 20 s, with an accuracy of 85%.
Conclusion:
Despite high heterogeneity among included studies, manual pulse checks only achieved moderate accuracy with a prolonged duration. This suggests that manual pulse checks are unreliable in children for determination cardiac arrest state and need for ongoing CPR.
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