Emergency Medicine: All Areas
Emergency Medicine 9
Michael T. Stratton, MD, MS (he/him/his)
Point of Care Ultrasound Fellow
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
The American Heart Association and Society for Critical Care Medicine support the use of Point-of-Care Ultrasound(POCUS) use during cardiac arrest, in part as a means to identify the presence of reversible causes of the arrest such as cardiac tamponade. The use of bedside limited echocardiography during the time of pediatric cardiopulmonary resuscitation (CPR) has been understudied. Adult studies have demonstrated a prolonging of pulse checks when POCUS is utilized. How the use of POCUS impacts pulse check duration during CPR in the pediatric emergency department (PED) is not well understood.
The objective of our study was to compare the duration of pulse checks during CPR in the PED when POCUS was utilized for limited echocardiography versus when it was not.
We completed a retrospective video-based observational study of patients receiving CPR in a PED. Our primary outcome was duration in seconds of pulse checks when POCUS was used compared to pulse checks when POCUS was not utilized. Pulse checks included in final analysis were those where only pulse palpation took place with or without bedside limited echocardiography and not those where other interventions that could have affected pulse check duration occurred. We compared median pulse check duration among pulse checks with and without POCUS utilization using the Wilcoxon Rank Sum Test.
From May 2019 to May 2022 we observed 23 patients who underwent CPR in our PED and had POCUS utilized during CPR. The median age of our sample was 0.2 years (IQR 0.1- 2.6 years). 114 pulse checks with pulse palpation were observed, 87 without POCUS and 27 with POCUS. The median pulse check duration for our sample was 10 seconds (IQR 8-13). The median pulse check duration without POCUS was 10 seconds (IQR 7-13), and the with POCUS was 13 seconds (IQR 9-15) When compared to pulse checks without POCUS use, the duration of pulse checks with POCUS use was not significantly longer (p-value=0.059).
In a video-review based observational study of PED patients in cardiac arrest, pulse check duration when POCUS was utilized showed a trend towards longer duration, but not to a statistically significant degree. Also, a great deal of variation exists in pulse check duration with and without POCUS. If POCUS is to be utilized during cardiac arrest in the PED, standardization of use with an emphasis on minimizing duration of pulse check is needed.