Comparison of manual pulse, carotid 2D ultrasound, and EtCO2 for detecting ROSC

Healthcare providers frequently spend excessive time identifying a pulse and have difficulties in precisely verifying its existence. Point-of-care carotid artery ultrasound has been suggested as a potential substitute technique for pulse checks. This study aimed to evaluate the effectiveness of manual pulse checks, 2D carotid ultrasonography (USG), and rapid increases in endtidal carbon dioxide (EtCO2) levels in determining the return of spontaneous circulation (ROSC) in patients who experienced a cardiac arrest in an emergency department (ED).

The study was designed as a single-center, prospective, observational study. Non-traumatic adult patients in cardiopulmonary arrest who were brought to the ED were included. Upon identifying cardiac arrest, the following data were recorded: the initial arrest rhythm, ultrasonographic and manual pulse evaluations, EtCO2 levels, resuscitation period, and vital signs post-ROSC. Team leaders' judgement used for adjudication of ROSC used as the reference standart.

The investigation included 88 patients with a total of 642 CPR cycles administered to who suffered cardiopulmonary arrest. AUC values of the USG, EtCO2 and manual pulse checks were 0.974, 0.802 and 0.862 (p<0.001, p<0.001, p<0.001, respectively). AUC comparisons of USG vs manual pulse check and EtCO2 were significantly different, while manual pulse checks vs EtCO2 had no significant difference (p=0.001, p<0.001, p=0.167, respectively). The sensitivity of bedside USG for detecting carotid pulse was found to be 93.8%, with a specificity of 100%.

This study suggests that 2D carotid ultrasonography can be effectively utilized for detecting pulses in patients suffering cardiopulmonary arrest.