From the Guidelines
Pulse checks should be performed every 2 minutes during CPR cycles in Advanced Cardiac Life Support (ACLS), as this interval allows for the assessment of the patient's cardiac rhythm and the effectiveness of resuscitation efforts while minimizing interruptions to chest compressions 1.
Importance of Pulse Checks
Pulse checks are crucial during ACLS as they help determine if the patient has achieved return of spontaneous circulation (ROSC) or if continued CPR is necessary. The carotid artery is the preferred site for pulse assessment in adults, while the brachial artery is often used in infants.
Minimizing Interruptions to Chest Compressions
It is essential to minimize interruptions to chest compressions during pulse checks, as continuous, high-quality CPR is critical for maintaining perfusion to vital organs. If the patient has an advanced airway in place, continuous compressions can be performed without pauses for ventilation, but the 2-minute rhythm and pulse check interval should still be maintained 1.
Assessing Effectiveness of Resuscitation Efforts
During the pulse check, the team leader should also assess the effectiveness of resuscitation efforts and consider any necessary changes to the treatment algorithm. Remember that in cardiac arrest, time without compressions directly correlates with decreased survival, so efficiency during pulse checks is essential.
Key Considerations
- Pulse checks should be brief, lasting no more than 10 seconds, and should coincide with rhythm checks.
- The 2-minute rhythm and pulse check interval should be maintained even if the patient has an advanced airway in place.
- The team leader should assess the effectiveness of resuscitation efforts and consider any necessary changes to the treatment algorithm during the pulse check.
- Efficiency during pulse checks is crucial, as time without compressions directly correlates with decreased survival 1.
From the Research
Pulse Check Frequency in ACLS
- The American Heart Association's guidelines for advanced cardiac life support (ACLS) recommend that rhythm and pulse checks be deferred until completion of 5 compression:ventilation cycles or minimally for 2min 2.
- Current consensus guidelines suggest that chest compressions resume immediately after defibrillation attempts and that pulse checks be performed after 2min of chest compressions 2.
- There is no specific recommendation on the frequency of pulse checks during ACLS, but it is implied that pulse checks should be performed after each 2min cycle of chest compressions 2.
- The duration of post-shock pulselessness can vary, with some patients remaining pulseless for over 2min after defibrillation attempts 2.
Rationale for Pulse Check Frequency
- The majority of patients remain pulseless for over 2min after defibrillation attempts, supporting the recommendation to immediately resume chest compressions for 2min following attempted defibrillation 2.
- The duration of asystole before return of pulses can be longer than 120s beyond the shock gap in as many as 25% of patients, highlighting the importance of prompt chest compressions and pulse checks 2.
- While there is no direct evidence on the optimal frequency of pulse checks, the available data suggest that pulse checks should be performed after each 2min cycle of chest compressions to ensure timely detection of return of spontaneous circulation (ROSC) 2.