Experience pays in accuracy of pediatric pulse in cardiac arrest

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Diagnosis of cardiac arrest in children by pulse palpation alone is unreliable. At least 30 seconds are required, but accuracy and speed are related to clinical experience, according to a study in the June issue of Resuscitation.

Blinded rescuers (82 nurses, 71 doctors) palpated for a brachial pulse in 17 children (1 day to 11 years) with non-pulsatile extracorporeal circulation for cardiac arrest or cardiac failure. Timed rescuer decisions (pulse present/absent) were compared with non-blinded investigator decisions.

James Tibballs, MD, deputy director of the intensive care unit at Royal Children's Hospital in Melbourne, Australia, and colleagues found that cardiac arrest on 55 occasions was diagnosed by 76 percent of rescuers in a mean time of 30 seconds. Experienced rescuers diagnosed cardiac arrest in 25 seconds, inexperienced rescuers in 37 seconds.

Cardiac arrest absent on 98 occasions was confirmed by 79 percent of rescuers in 13 seconds. Experienced rescuers confirmed absent cardiac arrest in nine seconds, inexperienced rescuers in 21. The difference was significant.

Researchers found that the diagnosis of cardiac arrest compared to confirmation of absence took longer by all rescuers. The difference was significant between experienced and inexperienced rescuers. Twenty-eight of 33 experienced doctors diagnosed cardiac arrest or confirmed absence in a mean of 13 seconds, 49 of 61 experienced nurses in 15 seconds, 11 of 21 inexperienced nurses in 18 seconds and 31 of 38 inexperienced doctors in 30 seconds.

Overall accuracy was 78 percent, sensitivity 76 percent and specificity 79 percent. Experienced doctors were 85 percent accurate, inexperienced doctors 82 percent, experienced nurses 80 percent and inexperienced nurses 52 percent. Rescuers diagnosing quickly (less than 10 seconds) had 90 percent accuracy, in 11–20 seconds 77 percent accuracy and in 21–30 seconds 62.5 percent accuracy.

Investigators concluded that more emphasis should be placed on training of pulse palpitation in children.