Pulses During CPR are Venous
Pulses During CPR are Venous
Hilty WM, et al. Real-time ultrasound-guided femoral vein catheterization during cardiopulmonary resuscitation. Ann Emerg Med 1997;29:331-336.
The purpose of this investigation was to compare the use of real-time ultrasound guidance with the standard landmark-oriented approach for obtaining femoral vein catheterization during CPR. Twenty patients were studied, each receiving bilateral femoral lines, one by ultrasound guidance and one by the landmark approach (control). Real-time ultrasound-guided catheterization had a higher success rate (90% versus 65%), a lower number of needle passes (2.3 versus 5.0), and a lower rate of arterial catheterization (0% versus 20%) than the standard landmark-oriented approach. An incidental finding of interest was that real-time ultrasound demonstrated the presence of femoral vein pulsations during CPR.
Commentary
The stated purpose of this study was to demonstrated the efficacy of real-time ultrasound to guide femoral vein catheterization during CPR. As an aside, the authors came across a most interesting (though not new) finding -- palpable femoral pulsations during CPR were venous rather than arterial. Despite the fact that the authors consider this to be an incidental finding, I believe it is the most significant discovery of the entire study. This is the first paper in quite a while that has mentioned arterial versus venous pulsations and the only one I am aware of to demonstrate the difference using real-time ultrasound. The implications of this finding are significant. We have traditionally used the palpable femoral "pulse" as a way to monitor CPR. Moreover, it is a common site from which to draw blood gases. Because there is a good chance the "femoral pulse" is actually a venous pulsation, it is relatively easy to assume that a gas is arterial when, in fact, it is really venous.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.