Cardiopulmonary Resuscitation (CPR) is a time-sensitive intervention designed to circulate oxygenated blood to the brain and other vital organs when the heart has stopped. A rapid assessment of circulation is the necessary first step. The carotid pulse check has historically been the standard method to determine if immediate chest compressions are required. This check must be performed quickly and accurately, as delaying CPR significantly reduces the chance of survival.
The Maximum Duration for Checking
The maximum time limit for assessing the carotid pulse is 10 seconds. This stringent guideline is mandated by major resuscitation councils, including the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR), for trained healthcare professionals. The 10-second constraint exists because prolonged pauses in circulation are extremely detrimental, and delaying chest compressions can be fatal. If a trained rescuer cannot definitively confirm a pulse within this brief window, they must immediately initiate chest compressions. This aggressive approach prioritizes the immediate restoration of circulation over spending valuable time searching for an ambiguous pulse.
For lay rescuers, the guidelines are simplified due to the difficulty in accurately checking a pulse. Lay rescuers are advised to skip the pulse check entirely and instead focus on whether the person is unresponsive and not breathing normally. If the victim meets these two criteria, the rescuer should immediately begin chest compressions, ensuring no time is wasted.
Locating the Carotid Pulse
The carotid pulse is the preferred site for checking circulation in adults and children because the carotid artery is large and close to the heart, making the pulse detectable even when blood pressure is low. To locate it, the rescuer should use the index and middle fingers, avoiding the thumb, which has its own strong pulse that can lead to a false reading. The correct placement is on the side of the neck, positioned in the groove between the trachea and the large muscles. The rescuer should locate the center of the trachea and slide their fingers laterally into the shallow depression next to it. Apply gentle pressure to feel for the rhythmic beating of the pulse, being careful not to press too firmly, which could collapse the artery.
Deciding the Next Step in CPR
The outcome of the 10-second pulse check dictates the immediate subsequent action in CPR for trained providers. If the rescuer determines there is no pulse, or if the pulse is uncertain at the 10-second mark, the immediate next step is to begin high-quality chest compressions. Compressions are performed in cycles of 30 compressions followed by two rescue breaths (the 30:2 ratio). The goal is to minimize the hands-off time between the pulse check and the start of compressions to ensure continuous blood flow.
If a definitive pulse is found, but the person is not breathing or is only gasping, the rescuer should not start chest compressions. In this scenario, the heart is still circulating blood, requiring rescue breathing only. For an adult, the rescuer should provide one breath every five to six seconds (10 to 12 breaths per minute). The pulse must be reassessed frequently, typically every two minutes, to ensure the heart has not stopped.
The distinction between lay rescuers and healthcare providers remains paramount in the decision-making process. Lay rescuers bypass the pulse check and initiate compressions if the person is unresponsive and not breathing normally, simplifying the process to reduce delays. Healthcare professionals use the 10-second pulse check to tailor the intervention, providing rescue breathing only if a pulse is confirmed, or immediate compressions if it is not.