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Arterial Doppler Ultrasound Blood Flow Waveforms During Chest Compressions to Detect Arterial Line Pulsatility.
Daniel M Rolston1, Nicholas Bielawa1, Xueqi Huang1
1Northwell, New Hyde Park, New York, NY.
Annals of Emergency Medicine
|October 18, 2025
Summary
Doppler ultrasound waveforms during chest compressions can accurately detect arterial line pulsatility, aiding in the assessment of return of spontaneous circulation. Specific waveforms show high sensitivity and specificity for identifying circulation return in cardiac arrest patients.
Area of Science:
- Emergency Medicine
- Critical Care
- Diagnostic Imaging
Background:
- Return of spontaneous circulation (ROSC) is a critical indicator during cardiac arrest resuscitation.
- Assessing ROSC often relies on pulse checks, which can be challenging and subjective.
- Doppler ultrasound offers a potential non-invasive method to evaluate blood flow during resuscitation efforts.
Purpose of the Study:
- To evaluate the diagnostic accuracy of specific Doppler ultrasound blood flow waveforms during chest compressions.
- To determine if these waveforms can reliably detect arterial line (a-line) pulsatility, indicating ROSC.
- To compare the association of different waveforms with systolic blood pressure (SBP) during pulse checks.
Main Methods:
- Retrospective diagnostic accuracy study of adult cardiac arrest patients with femoral arterial lines.
- Analysis of prospectively collected Doppler ultrasound clips of the femoral artery during chest compressions.
- Calculation of accuracy, sensitivity, and specificity of identified waveforms (bidirectional, minimal, anterograde dominant, pulsatility through compressions) for detecting a-line pulsatility.
Main Results:
- Doppler ultrasound waveforms demonstrated 88.9% overall accuracy in detecting a-line pulsatility.
- Pulsatility through compressions or anterograde dominant blood flow showed high sensitivity (97.7%) for detecting a-line pulsatility.
- Bidirectional or minimal blood flow had good specificity (81.5%) for indicating absence of a-line pulsatility.
- Systolic blood pressure was significantly higher with pulsatility through compressions compared to anterograde dominant blood flow.
Conclusions:
- Arterial Doppler ultrasound waveforms during chest compressions possess favorable diagnostic characteristics.
- These waveforms are effective in identifying arterial line pulsatility, suggesting ROSC.
- Ultrasound assessment during compressions can be a valuable adjunct in cardiac arrest management.
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