The carotid pulse check revisited: What if there is no pulse?

This study was undertaken to evaluate the diagnostic accuracy and time requ ired by first responders to assess the carotid pulse in potentially pulsele ss patients, We conducted a prospective, randomized study of first responde rs (n = 206; four different training levels) and were blinded as to the pat ients' conditions in the cardiac operating rooms of a university hospital, Sixteen patients underwent coronary artery bypass surgery on nonpulsatile c ardiopulmonary bypasses. Carotid pulse check was performed either during pu lsatile (spontaneous) or during nonpulsatile (extracorporeal) circulation. Patients' hemodynamic status at the time of assessment, diagnostic accuracy of the first responders, and the time required to diagnose carotid pulsati lity or pulselessness were documented. Within 10 sees, only 16.5% of the pa rticipants (34 of 206) were able to reach any decision about their patients ' pulse status, Assessments that were both rapid and correct (15%, i.e., 31 of 206) occurred almost exclusively in pulsatile patients. Advanced traini ng level shortened the delay to decision and improved its accuracy. However , merely 2% of the participants (1 of 59) correctly recognized a truly puls eless patient within 10 sees. Recognition of pulselessness of the carotid a rtery by rescuers with basic cardiopulmonary resuscitation training is time -consuming and highly inaccurate. Although the carotid pulse check needs to be taught, its importance in the context of layperson basic life support s hould be de-emphasized.