Return of Spontaneous Circulation (ROSC) signifies the resumption of a sustained heart rhythm that effectively circulates blood throughout the body after cardiac arrest. This means the heart has started beating on its own, often accompanied by signs like breathing, coughing, or movement, and a detectable pulse or blood pressure. Identifying ROSC is a significant milestone during resuscitation efforts.
The Importance of Accurate Pulse Assessment
Accurately checking for a pulse following suspected ROSC is paramount, as it directly influences subsequent life-saving interventions. Continuing chest compressions on a patient who has regained a pulse can be harmful, potentially causing injury to a beating heart or delaying other medical care. Conversely, failing to recognize the absence of a pulse and ceasing compressions too early can be fatal, as the patient still requires circulatory support.
Rapid and correct assessment guides whether to continue cardiopulmonary resuscitation (CPR) or transition to post-resuscitation care. Minimizing interruptions to chest compressions during pulse checks is important, as continuous, high-quality CPR helps maintain blood flow to vital organs. A quick and accurate pulse check ensures appropriate immediate actions, maximizing positive outcomes.
Key Locations for Pulse Assessment
When assessing for a pulse after suspected ROSC, perform the check for no more than 10 seconds to quickly determine its presence or absence, minimizing interruptions to potential chest compressions. The location and technique vary depending on the patient’s age.
Adults
For adults, the carotid pulse in the neck is the primary location. To check this pulse, rescuers should place their index and middle fingers on the side of the windpipe, in the groove between the trachea and the large neck muscle. Apply gentle pressure to feel for a rhythmic pulsation. Avoid excessive force or palpating both carotid arteries simultaneously, as this can compromise blood flow to the brain.
Infants
For infants (under one year of age), the brachial pulse in the upper arm is the preferred site. To locate the brachial artery, feel along the inside of the upper arm, between the shoulder and the elbow. Place two or three fingers gently on this area, applying light pressure to feel for a pulse, as too much pressure can occlude the artery.
Children
For children (one year to puberty), the carotid pulse is often used, similar to adults. The femoral pulse can also be an alternative, located in the inner thigh, in the crease where the leg joins the abdomen, between the pubic bone and the hip bone. Use two fingers to feel for a pulse.
Interpreting Pulse Findings and Immediate Actions
Pulse assessment findings dictate immediate next steps in patient care. The goal is to ensure continuous, appropriate support for the patient’s circulatory and respiratory systems.
If a pulse is present, the immediate focus shifts to supporting ventilation and circulation. If the patient is not breathing normally, rescue breaths should be administered, one breath every 3 to 5 seconds for adults, children, and infants. Continuous monitoring of vital signs, including pulse, blood pressure, and oxygen saturation, is necessary. Preparing for transport to a medical facility for comprehensive post-cardiac arrest care, including identifying and treating the underlying cause of the arrest, is the next priority.
If no pulse is detected within the 10-second assessment period, or if there is uncertainty about the presence of a pulse, high-quality chest compressions must be immediately resumed. Resuscitation efforts should continue, alternating compressions with ventilations, until advanced medical help arrives or the patient regains a sustained pulse and normal breathing. The critical decision to continue or stop CPR relies heavily on the accurate and timely assessment of a pulse.