Benefit of pocus over pulse checks

Benefits of Point-of-Care Ultrasound (POCUS) compared to pulse checks during cardiopulmonary resuscitation (CPR):

• POCUS pulse checks provide a more reliable and valid detection of the return of spontaneous circulation (ROSC) compared to manual pulse palpation, especially in conditions like pulseless electrical activity (PEA) where perfusion might be present but not palpable with traditional methods NICE CKS Betz et al. 2025.
• POCUS pulse checks are feasible to perform within the guideline-recommended duration of less than 10 seconds, often taking even less time than manual pulse checks (6.1 seconds vs 7.3 seconds on average) on simulation studies, ensuring minimal interruption to chest compressions during CPR NICE CKS Betz et al. 2025.
• POCUS reduces the risk of false-negative pulse assessments inherent in manual palpation caused by factors like low pulse pressure, agitation, or misplacement, thus improving clinical decision-making and potentially avoiding unnecessary continuation or cessation of CPR NICE CKS Betz et al. 2025.
• POCUS use during CPR also allows immediate identification of reversible causes of cardiac arrest and guides post-ROSC management, thereby extending its utility beyond pulse detection NICE CKS Betz et al. 2025.
• POCUS has the advantage of providing visual confirmation of circulation, which may improve team confidence and accuracy in rhythm analysis and pulse checks, compared to the subjective and sometimes unreliable feel of pulses in critical situations NICE CKS Betz et al. 2025.
• Although POCUS may be perceived as taking longer or more complex, properly trained providers can perform ultrasound pulse checks without significant delays or interruption to CPR, and the technique is rated as easy and useful by multidisciplinary resuscitation teams NICE CKS Betz et al. 2025.
• POCUS is adaptable across various provider types and experience levels, including physicians, nurses, and emergency medical services personnel, making it a versatile adjunct during resuscitation NICE CKS.
• Potential limitations include the need for training, equipment availability, and the possibility of longer turnaround times in real-life emergency scenarios compared to simulations, thus integration into clinical practice requires careful workflow optimization and further clinical validation NICE CKS.
• In emergency airway management, POCUS has demonstrated benefits over palpation techniques for anatomical landmark identification in procedures like emergent cricothyroidotomy (EC), offering improved accuracy in difficult anatomical situations, although palpation remains faster and equally effective in user confidence in simulations Dotson et al. 2024.
• Therefore, the clinical benefits of POCUS compared to manual pulse or landmark checks include improved accuracy and reliability, potential avoidance of unnecessary interventions, and expanded diagnostic capabilities, balanced against the need for operator skill and procedural timing considerations NICE CKS,Dotson et al. 2024 Betz et al. 2025 Dotson et al. 2024.