POCUS in pediatric arrest (Res-US pulse check): development and evaluation of a simulation-based curriculum

Pediatric Advanced Life Support guidelines recommend pulse assessment within 10-s, yet manual palpation during pediatric cardiac arrest is often inaccurate. Point-of-care ultrasound (POCUS) can improve detection of arterial pulsatility, identify cardiac activity or standstill, and diagnose reversible causes of arrest. However, pediatric-specific protocols for integrating POCUS into cardiac arrest management are limited, and concerns persist that POCUS may prolong interruptions in CPR. This study aimed to develop, implement, and evaluate a structured protocol integrating POCUS into pediatric cardiac arrest management.

We designed a simulation-based curriculum using rapid cycle deliberate practice. A flipped-classroom model combined an online module with in-person simulation. The primary outcome of the study was pulse detection accuracy (correct identification of pulse presence/absence). Secondary outcomes for the online module included completion of responses within 10-s and interpretation time. For in-person simulation sessions, secondary outcomes included decision time, CPR pause duration, self-reported confidence and perceived skill improvement.

37 physicians (21 PEM faculty, 16 fellows) completed the online module (total of 740 pulse checks). Pulse detection accuracy was 88.0% for pulse presence and 89.3% for absence; 86.5% met the 10-s target, with a median interpretation time of 5 s. During simulation, accuracy was 100% (5/5) for pulse presence and 94% (17/18) for pulselessness. Median decision time was 4.6 s (IQR 3.8-8.1). Confidence increased from 2.5/5 to 3.9/5 (Cohen's d = 1.47, large effect size), with high satisfaction reported.

A structured POCUS pulse-check curriculum was associated with improved accuracy, efficiency, and clinician confidence without prolonging CPR pauses, suggesting that a multimodal training approach may support integration of POCUS into pediatric resuscitation.