• Romolo J Gaspari, Robert Lindsay, Andrew Dowd, and Timothy Gleeson.
• Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA. Electronic address: Romolo.Gaspari@umassmemorial.org.
• Ann Emerg Med. 2023 May 1; 81 (5): 523531523-531.

Study ObjectiveThis study explored femoral arterial Doppler during active cardiopulmonary resuscitation (CPR) to identify and characterize the resumptions of cardiac activity without stopping CPR.MethodsThis was a proof-of-concept study exploring arterial Doppler during cardiac arrest. Patients in cardiac arrest undergoing active CPR were prospectively enrolled. Arterial Doppler of the common femoral artery was recorded during CPR and during pauses in CPR. CPR-induced arterial tracings and native cardiac-induced tracings were analyzed for rate and peak systolic velocity. Cardiac activity on echocardiogram during pause in CPR was classified as "absent," "disorganized," or "organized." Descriptive data and survival are presented as mean and 95% confidence intervals (CI), as well as sensitivity and specificity of Doppler during active CPR in detecting native cardiac pulsations.ResultsSixteen patients with 48 paired Doppler recordings during active CPR, pause in CPR, and associated echocardiogram were enrolled. Native cardiac-induced tracings were visible during 39.6% of pauses in CPR (19 of 48) and during 18.8% of the periods of active CPR (9 of 48). Arterial pulsations were more frequently visualized with organized contractions by echocardiogram (10 of 14, 71%) than disorganized contractions (9 of 22, 41%). Arterial Doppler was 100% specific and 50% sensitive in detecting organized cardiac activity during active CPR. Patients with visible native cardiac pulsations during active CPR demonstrated 0% mortality compared with 67% mortality without visible arterial pulsations.ConclusionArterial Doppler tracings may identify the resumption of native cardiac activity during active CPR; however, more research is needed.Copyright © 2022 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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