Femoral Artery Ultrasound in Cardiac Arrest

The Study
Cohen AL et al. Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest. Resuscitation 2022;173: 157-165.

When we are in the ACLS resuscitation algorithm, following each cycle of compression, we need to perform a rhythm/pulse check. However this can be a challenge for many reasons including: body habits, room temperature, experience and situational stress.

Doppler ultrasound can not only detect a pulse, but can also read peak systolic velocity (PSV), which correlates with systolic blood pressure (in non-cardiac arrest patients).

This study had two objectives:

1. To assess the accuracy of femoral artery pulsed-wave Doppler ultrasound in comparison to manual palpation to detect any pulse with an arterial line waveform for patients in cardiac arrest.
2. To determine whether peak systolic velocity (PSV) on Doppler ultrasound accurately detects a pulse with an adequate blood pressure needed for perfusion, which we defined as a SBP > 60 mmHg. 

What They Did

This was a prospective, cross-sectional, partially blinded, diagnostic accuracy study, performed in one emergency department.

Patients included:

• > 18 years old.
• Non-traumatic cardiac arrest.
• Had a femoral arterial line in place

Emergency Physicians were trained in femoral artery pulsed-wave doppler ultrasound performance

Manual palpation was at the femoral or carotid arteries.

Ultrasound was performed and when the femoral artery was identified, the pulsed wave doppler function was enabled.

Primary Outcome