Where should I check the pulse during Cardiopulmonary Resuscitation (CPR)?

Where to Check Pulse in CPR

During CPR, healthcare providers should check for a pulse at the carotid artery, taking no more than 10 seconds to determine if a pulse is present. 1

Proper Pulse Check Technique

For Healthcare Providers:

• Check for responsiveness and absence of normal breathing (or only gasping)
• When checking for a pulse:
  • Use the carotid artery (located in the neck)
  • Take no more than 10 seconds to determine if a pulse is present 1
  • If you do not definitely feel a pulse within 10 seconds, begin chest compressions 1

For Lay Rescuers:

• Lay rescuers should NOT check for a pulse 1
• Instead, they should begin CPR if the victim is:
  • Unresponsive
  • Not breathing normally (or only gasping) 1

Evidence Supporting Carotid Pulse Check

The carotid artery is the recommended site for pulse checks during CPR for several important reasons:

• It has higher sensitivity compared to the femoral artery for pulse detection 2
• It provides more reliable information about central circulation
• It is easily accessible during resuscitation efforts

Research comparing femoral and carotid arteries found that the carotid artery had significantly higher sensitivity with similar specificity for pulse detection during CPR 2.

Challenges with Pulse Checks

It's important to recognize the limitations of manual pulse checks:

• Healthcare providers often take too long to check for a pulse 1
• Even trained professionals have difficulty determining if a pulse is present or absent 1
• Studies show that 45% of carotid pulses may be pronounced absent even when present 1
• Only 15% of rescuers can produce correct pulse check diagnoses within 10 seconds 3

These limitations highlight why:

1. The 10-second time limit is critical
2. Lay rescuers are not taught to check pulses
3. Healthcare providers should start compressions if they don't definitely feel a pulse

Emerging Alternatives

Recent research suggests potential alternatives to manual pulse checks:

• Carotid ultrasound (c-USG) has shown superior sensitivity (100%) and specificity (98%) compared to manual methods (80% sensitivity, 91% specificity) 4
• Point-of-care ultrasound for carotid pulse assessment has demonstrated high interobserver reliability 5

However, these technologies are not yet incorporated into current guidelines, which still recommend the traditional carotid pulse check for healthcare providers.

Key Points to Remember

• Healthcare providers: Check the carotid pulse for no more than 10 seconds
• If no definite pulse is felt within 10 seconds, begin chest compressions
• Lay rescuers: Do not check for a pulse; begin CPR based on unresponsiveness and abnormal breathing
• When in doubt, it is better to start compressions than to delay CPR

The carotid pulse check remains the standard approach for healthcare providers during CPR, despite its limitations, as it represents the best balance of accessibility and reliability for detecting central circulation.