Can a line be used only for pulse checks during cardiac arrest?

Using Arterial Lines for Pulse Checks During Cardiac Arrest

Arterial lines should be used for pulse checks during cardiac arrest when available, as they provide continuous, reliable hemodynamic monitoring that can detect return of spontaneous circulation (ROSC) without interrupting chest compressions.

Benefits of Arterial Line Monitoring During Resuscitation

Arterial line monitoring during cardiac arrest offers several advantages:

• Continuous hemodynamic assessment: Allows real-time monitoring of blood pressure without interrupting chest compressions
• Early ROSC detection: Can identify return of circulation before it might be detected by manual pulse checks
• Optimization of CPR quality: Provides feedback on compression effectiveness through arterial waveform and diastolic pressure

Evidence-Based Recommendations

The American Heart Association (AHA) guidelines support using arterial pressure monitoring during resuscitation when available:

• "It is reasonable to consider using arterial relaxation 'diastolic' pressure to monitor CPR quality, optimize chest compressions, and guide vasopressor therapy" 1
• "Arterial pressure monitoring can also be used to detect ROSC during chest compressions or when a rhythm check reveals an organized rhythm" 1

Practical Application

When an arterial line is in place during cardiac arrest:

1. Monitor the arterial waveform continuously during compressions
2. Observe for changes in waveform morphology that might indicate ROSC
3. Use the diastolic pressure to assess compression quality (target >20 mmHg)
4. Avoid unnecessary interruptions in chest compressions for manual pulse checks

Limitations and Considerations

While arterial lines provide valuable information, be aware of:

• Damping or artifact: Ensure the line is functioning properly and not obstructed
• Positioning: The transducer should be properly zeroed and positioned at the phlebostatic axis
• Technical issues: Arterial line disconnection or failure can occur during resuscitation

Manual Pulse Check Limitations

Traditional manual pulse checks have significant limitations:

• Studies show poor accuracy in detecting pulses, with specificity as low as 55% 2
• Manual pulse checks require interruption of chest compressions, reducing CPR quality
• Even trained professionals often take longer than the recommended 10 seconds to determine pulse status 2

Alternative Approaches

If an arterial line is not available:

• Use other monitoring modalities like end-tidal CO2 to detect ROSC
• Minimize interruptions in chest compressions for pulse checks
• Consider newer approaches like continuous femoral pulse checks, which may provide earlier and more effective information about pulse status 3

By using arterial lines for pulse detection during cardiac arrest, providers can maintain high-quality CPR with fewer interruptions while gaining valuable hemodynamic information to guide resuscitation efforts and detect ROSC.