Is it Time to Pause Pulse Checks?

High-quality CPR depends on minimizing interruptions, and routine pulse checks are a surprisingly common source of avoidable pause time. In cardiac arrest care, rhythm checks every 2 minutes align better with current ACLS thinking, while POCUS should answer a focused question without stopping compressions.

CPR Interruptions and Pulse Checks

• Chest compression fraction: Chest compression fraction tracks how much of the resuscitation is spent actually compressing the chest, and higher fractions are linked to better ROSC and functional outcomes.
• Pulse check inaccuracy: Manual pulse checks are both slow and unreliable, with studies showing 17 to 24 seconds to decide and accuracy around 78%, making them a poor trade for lost compression time.
• Guideline shift away: AHA guidance has moved away from routine pulse checks during CPR, even for presumed ROSC, while keeping the emphasis on near-continuous compressions.
• Rhythm check priority: Rhythm checks every 2 minutes identify actionable rhythms like VF or VT for defibrillation, and asystole does not require a pulse check before CPR continues. That practice change is worth hearing in the episode.
• Arterial line exception: An arterial line can help confirm perfusion in the right patient, but it does not change the larger bedside principle that routine pulse palpation should stop.

POCUS During Cardiac Arrest

• Ultrasound pause penalty: POCUS during arrest is associated with longer CPR pauses, and transthoracic scans commonly push interruptions beyond the 10-second target.
• TEE over TTE: Transesophageal echo shortens compression pauses compared with transthoracic imaging, with reported pauses of 9 seconds versus 19 seconds.
• Targeted ultrasound question: Ultrasound should start with a specific diagnostic question, with image capture kept brief and interpretation handed off while compressions continue. We get into that workflow in the episode.
• CPR first principle: POCUS can add useful information during resuscitation, but it should never delay ongoing high-quality CPR or become the reason compressions stop.

References:

• Stop Performing Routine Pulse Checks During CPR - ACEP Now
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