Demonstration of Doppler Ultrasound Pulse Detection by Trained Prehospital Personnel

Abstract

Background and Aim: Data suggests that finger palpation of the carotid and/or femoral pulses is significantly less sensitive than 100%. In some cases, a patient who does, in fact, have organized cardiac function, may be identified as being in Pulseless Electrical Activity (PEA). Chest compressions performed as indicated by these circumstances may not provide significant therapeutic benefit to those patients and may, in fact, distract from better directed therapies. Doppler Ultrasonography (DUSG) has been shown to be more sensitive than human fingers. This research aims to assess whether EMT-Basics and Paramedics can be quickly and inexpensively trained to use DUSG as a tool for pulse detection. Methods: Participants viewed a recorded video 4 minutes 18 seconds in length which detailed an anterior-to-posterior fanning technique for assessing presence of a carotid pulse using a doppler ultrasound device. The participants were given a short period of time to practice and familiarize themselves with the device. Participants were then timed while demonstrating application of ultrasound-conducting gel to a volunteer and using the device to detect a carotid pulse. The time recording ceased when the participant verbalized confirmation of the pulse, and their success or failure was annotated. Results: Credentialed EMT-Basics and Paramedics, with minimal training, consistently demonstrated the ability to accurately and rapidly assess a carotid pulse using a doppler ultrasound device. Conclusions: This research suggests that prehospital personnel can be efficiently trained to use available and inexpensive doppler ultrasound devices to determine cardiac pulse status. Furthermore, it suggests that the technique itself can be used to detect the carotid pulse quickly and accurately. Further research in patient care settings should be undertaken to evaluate the utility of doppler ultrasound devices in distinguishing PEA from Pseudo-PEA.