Serial Ultrasound-Guided Carotid Artery Compression During Chest Compressions for Assessing Circulatory Status: A Prospective Pilot Diagnostic Study

Background Point-of-care ultrasound-carotid artery compression (POCUS-CAC) is a technique using ultrasound to assess carotid artery compressibility during pulse checks. We expanded the use of POCUS-CAC during ongoing chest compressions for identifying circulatory status at the subsequent rhythm check. Methods A prospective, single-center study was conducted on patients aged ≥18 years presenting to the emergency department with cardiac arrest between June 2022 and October 2023. POCUS-CAC was performed at approximately 30 s intervals during ongoing chest compressions whenever clinically feasible. A POCUS-CAC assessment was classified as ROSC-compatible if the carotid artery remained non-compressible during both the systolic and diastolic phases of chest compressions. Circulatory status at the subsequent rhythm check was determined according to the 2020 American Heart Association guidelines. The diagnostic performance was evaluated using conventional diagnostic performance measures, with 95% confidence intervals estimated using patient-level cluster bootstrap resampling. Results Among 37 patients, 296 POCUS-CAC assessments were analyzed. POCUS-CAC during ongoing chest compressions demonstrated 90.6% sensitivity, 84.9% specificity, and 87.2% accuracy for identifying circulatory status at the subsequent rhythm check. In exploratory longitudinal analyses, diagnostic performance remained generally consistent across the first three assessments within cardiopulmonary resuscitation cycles. Conclusions POCUS-CAC during ongoing chest compressions showed favorable diagnostic performance for identifying circulatory status at the subsequent rhythm check. Serial POCUS-CAC assessments may provide additional information regarding changes in circulatory status during ongoing CPR. Further prospective multicenter studies are needed to validate these findings.