Arterial Doppler Ultrasound Blood Flow Waveforms During Chest Compressions to Detect Arterial Line Pulsatility - 18/10/25
, Nicholas Bielawa, DMSc, PA-C, Xueqi Huang, MS, Alexander V. Nello, DO, Ghania Haddad, MD, Daniel Jafari, MD, MPH, Timmy Li, PhD, Lance B. Becker, MD, Allison L. Cohen, MDAbstract |
Study objective |
Doppler ultrasound blood flow waveforms during active chest compressions are unique and may allow identification of return of spontaneous circulation. We assessed diagnostic accuracy of 4 identified Doppler ultrasound blood flow waveforms—(1) bidirectional blood flow, (2) minimal blood flow, (3) anterograde dominant blood flow, and (4) pulsatility through compressions—during chest compressions to detect arterial line (a-line) pulsatility during a subsequent pulse check. Secondarily, we assessed if pulsatility through compressions was associated with higher systolic blood pressure (SBP) at pulse check than anterograde dominant blood flow.
Methods |
We conducted a retrospective, diagnostic accuracy study on a prospectively collected convenience sample of adult, emergency department cardiac arrest patients. All patients had a femoral a-line. Prior to a pulse check, Doppler ultrasound clips of the femoral artery were saved and reviewed. During a pulse check, the presence or absence of an arterial line waveform and the highest SBP were recorded. Accuracy, sensitivity, and specificity of the blood flow waveforms were calculated using generalized estimating equation models.
Results |
Forty-four patients with 123 Doppler ultrasound waveforms and subsequent pulse checks were analyzed. Accuracy of the Doppler ultrasound waveforms was 88.9% (95% confidence interval [CI] 81.3 to 93.7), sensitivity of pulsatility through compressions or anterograde dominant blood flow to detect a-line pulsatility was 97.7% (95% CI 87.7 to 99.6), and specificity of bidirectional blood flow or minimal blood flow for the absence of a-line pulsatility was 81.5% (95% CI 69.3 to 89.6). Estimated least-squares mean SBP was higher (50.9 mmHg [95% CI 25.6 to 76.1 mmHg]) for pulsatility through compressions than anterograde dominant blood flow waveforms.
Conclusion |
Arterial Doppler ultrasound waveforms during chest compressions had good diagnostic test characteristics for detecting arterial line pulsatility at subsequent pulse check.
Le texte complet de cet article est disponible en PDF.Keywords : Cardiac arrest, Return of spontaneous circulation, Doppler ultrasound, Blood flow waveforms
Plan
| Please see page XX for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Keith A. Marill, MD, MS. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: DR: conceptualization, methodology, validation, formal analysis, investigation, data curation, writing – original draft, writing – review and editing, visualization, supervision, project administration, funding acquisition. NB: methodology, validation, investigation, data curation, writing – review and editing, funding acquisition. XH: methodology, software, validation, data curation, formal analysis, writing – review and editing, visualization, administration. AN: methodology, validation, investigation, data curation, writing – review and editing. GH: software, validation, formal analysis, investigation, data curation, writing – original draft, writing – review and editing, visualization. DJ: methodology, validation, investigation, data curation, writing – review and editing. TL: methodology, software, validation, formal analysis, investigation, writing – review and editing, project administration. LB: conceptualization, methodology, investigation, validation, supervision, writing – review and editing. AC: conceptualization, methodology, validation, formal analysis, investigation, writing – review and editing, supervision, project administration. DR takes responsibility for the paper as a whole. |
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| Data sharing statement: All research data are available on request. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Fundingandsupport: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). This study was supported by a grant from the ZOLL Foundation. The ZOLL Foundation was not involved in the study design, data collection, analysis or interpretation of data, writing of the manuscript, or decision to publish the manuscript. Dr. Rolston’s institution received research funding from Flosonics Medical related to the current study and the ZOLL Foundation and CalciMedica unrelated to the current study. Dr. Bielawa’s institution received research funding from the ZOLL Foundation for this study. Dr. Jafari’s institution received research funding from the ZOLL Foundation and Theravance Biopharma unrelated to the current study. Dr. Li’s institution received research funding from the National Institutes of Health and the ZOLL Foundation unrelated to the current study. Dr. Becker’s institution receives research funding from the National Institutes of Health, United Therapeutics, Philips, ZOLL, and Hewlett-Packard unrelated to the current study; he also serves on the scientific advisory boards for: Nihon Kohden Medical, Philips Corp, and Hewlett-Packard. Dr. Cohen’s institution received research funding from the ZOLL Foundation for a portion of the work in this study and Flosonics Medical unrelated to the current study. Dr. Rolston, Dr. Li, and Drs. Becker and Cohen have patent #US20240041696A1 issued to Feinstein Institutes for Medical Research. |
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