Cardiopulmonary Resuscitation (CPR) is a life-saving procedure that keeps oxygenated blood flowing to the brain and other organs when a person’s heart has stopped. The pulse check is a brief but crucial assessment point for rescuers. Improperly timed or extended pulse checks can be detrimental because they interrupt chest compressions, which are necessary to circulate blood. Understanding the correct timing for this assessment is paramount to maximizing the patient’s chance of survival.
The Purpose of the Pulse Check
The pulse check is performed for two primary reasons during a cardiac emergency. First, it helps confirm the initial diagnosis of cardiac arrest in an unresponsive individual who is not breathing or is only gasping. If a rescuer cannot definitively feel a pulse, the heart is presumed to be ineffective or stopped, signaling the need for immediate chest compressions.
The second reason is to assess for the Return of Spontaneous Circulation (ROSC) during the resuscitation effort. ROSC means the heart has begun beating effectively enough on its own to create a palpable pulse. Rescuers typically check the carotid artery in the neck of adults and children, as this large artery is the most accessible for detecting central blood flow. A foundational rule is that the interruption of chest compressions for any pulse check must not exceed 10 seconds.
Timing Guidelines for Lay Rescuers
Current guidelines for lay rescuers, who are members of the general public without medical training, largely de-emphasize the pulse check entirely. Lay rescuers are often taught Hands-Only CPR, which focuses solely on continuous chest compressions. This approach is based on evidence showing that untrained individuals frequently struggle to accurately confirm a pulse within the strict 10-second timeframe, leading to harmful delays.
Instead of looking for a pulse, a lay rescuer should activate emergency services and immediately begin chest compressions if the person is unresponsive and not breathing normally. Starting compressions without delay is significantly more beneficial than losing precious seconds attempting to confirm a pulse. The only exception where a lay rescuer might pause is if the victim begins showing obvious signs of life, such as purposeful movement or coughing.
Timing Guidelines for Certified Healthcare Providers
Certified healthcare providers follow a more structured protocol for checking the pulse. Their initial assessment upon finding an unresponsive patient involves simultaneously checking for breathing and a pulse, a step that must be completed within the 10-second window. Failure to confirm a pulse within this time dictates an immediate start to chest compressions.
During active resuscitation, the pulse check is integrated into the two-minute cycles of CPR, coinciding with a planned pause for a rhythm check using a defibrillator. After every two minutes of continuous compressions and ventilations, the team briefly stops to assess the patient’s heart rhythm and check for a pulse. This 10-second pause is precisely timed to minimize the interruption of blood flow. For organized teams, the pulse check is often timed to align with the planned switch of the rescuer performing compressions, further reducing overall downtime.
Responding to Pulse Check Results
The result of the pulse check dictates the immediate next step in the resuscitation effort, whether performed by a layperson or a healthcare provider. If the pulse check reveals that a pulse is absent, or if the rescuer is uncertain whether a pulse is present, the protocol demands the immediate resumption of chest compressions. Continuing compressions is the safest action, as the harm from performing unnecessary compressions on a beating heart is minimal compared to withholding compressions from a heart that needs them.
Conversely, if a pulse is definitively present, it signifies the achievement of Return of Spontaneous Circulation (ROSC). When ROSC is confirmed, chest compressions must be stopped immediately. The rescuer then transitions to monitoring the patient and providing rescue breathing if the patient is still not breathing normally, delivering one breath approximately every five to six seconds for an adult. The patient’s pulse and breathing must continue to be closely monitored until emergency medical services arrive to take over care.