Manual pulse palpation during cardiopulmonary resuscitation is unreliable and time-consuming. Point-of-care ultrasound (POCUS) has been proposed as a faster and more accurate alternative. We conducted a systematic review and meta-analysis to evaluate whether ultrasound pulse checks reduce assessment time and improve diagnostic performance compared to manual palpation.

A systematic search of PubMed, Embase, and Cochrane databases was performed. We included randomized and observational studies comparing the duration of ultrasound and manual pulse checks. Outcomes included mean pulse check duration and diagnostic sensitivity and specificity. Risk of bias was assessed using the Cochrane, Newcastle-Ottawa and Quadas tools, and evidence certainty was evaluated with GRADE. Random effects models were used for the meta-analyses.

Seven studies were included, comprising over 2900 ultrasound and over 1600 manual pulse checks. Ultrasound was associated with shorter pulse check durations (mean difference − 1.39 s; 95 % CI -2.20 to − 0.57). Subgroup analyses by anatomical site and clinical context consistently favored ultrasound. Pooled sensitivity and specificity for ultrasound were 99 % and 96 %, compared to 62 % and 91 % for manual palpation.

Ultrasound-guided pulse checks were associated with slightly shorter pulse check durations and higher diagnostic sensitivity compared to manual palpation. These findings support integration of ultrasound into resuscitation protocols should be considered with an understanding of the current limitations in evidence quality and generalizability, with further research needed to standardize training and implementation.