Cardiopulmonary resuscitation (CPR) is a time-sensitive intervention that helps sustain life when a person’s heart or breathing has stopped. The process begins with a rapid assessment to determine if circulation is present, which guides the decision on whether to start chest compressions. For trained rescuers, checking for a pulse is a necessary step that must be performed quickly to avoid delays in delivering life-saving care.
The Critical 5-to-10-Second Window
Current international resuscitation guidelines mandate a strict time limit for a pulse check. A trained rescuer should take no less than 5 seconds and no more than 10 seconds to determine if a pulse is present. This timing is related to “hands-off time,” which refers to any period when chest compressions are paused. Prolonged hands-off time severely reduces the pressure that supplies blood to the heart muscle, known as coronary perfusion pressure. If a pulse cannot be definitively felt within 10 seconds, the rescuer must immediately begin chest compressions, as the harm of withholding CPR outweighs the risk of giving compressions unnecessarily.
Identifying the Carotid Pulse Location
The carotid artery is the preferred site for checking circulation in an unresponsive adult or child during a CPR assessment. This major blood vessel is situated in the neck and supplies oxygenated blood directly to the brain. Its central location means the carotid pulse is often the last one to disappear during shock or cardiac arrest. To find the pulse, the rescuer should first locate the trachea, or windpipe, in the center of the neck. Using two or three fingers, the rescuer should slide laterally into the groove between the trachea and the large muscle on the side of the neck.
Decision Making After the Pulse Check
The result of the 5-to-10-second pulse check dictates the immediate next steps in the resuscitation effort. If a definitive pulse is felt, but the person is not breathing normally, the rescuer should begin rescue breathing without chest compressions, delivering one breath every 5 to 6 seconds for an adult. If no pulse is felt, or if the rescuer is uncertain after the maximum 10 seconds, chest compressions must be started right away. The immediate goal is to mechanically circulate blood to the brain and heart until emergency medical services arrive. The rescuer should continue cycles of compressions and rescue breaths until signs of life return or medical professionals take over, re-evaluating the pulse approximately every two minutes.