Reliability of manual pulse checks versus emerging techniques in pediatric resuscitation: a systematic review

Abstract

The accurate and rapid assessment of circulation is critical during pediatric cardiac arrest. Current guidelines recommend manual pulse checks, yet concerns remain regarding their reliability, as delays and inaccuracies may lead to inappropriate interruptions of cardiopulmonary resuscitation (CPR). Emerging techniques, such as point-of-care ultrasound (POCUS), offer potential objective alternatives. This systematic review aimed to synthesize the available evidence on the reliability of manual pulse checks compared with emerging techniques in pediatric resuscitation. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic search of PubMed, Web of Science, Scopus, and Embase was conducted without date restrictions. Eligible studies compared manual pulse palpation with techniques such as POCUS or auscultation in pediatric populations, either in simulated or clinical settings. Data on study characteristics, diagnostic accuracy, time to decision, and clinical outcomes were extracted, and the risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies - Version 2 (QUADAS-2) tool. A narrative synthesis was performed due to heterogeneity among studies. Six studies met the inclusion criteria. Overall, the evidence indicated notable limitations of manual pulse checks, while POCUS demonstrated greater reliability and faster decision-making, in addition to providing supplementary diagnostic information such as confirmation of cardiac activity. However, most of the available studies were based on simulations or small case series, underscoring the need for larger prospective trials. Manual pulse palpation appears to be an unreliable method for assessing circulation in pediatric cardiac arrest. POCUS shows promise as a more accurate and efficient alternative, with potential to improve the quality of resuscitation. Further research in real-world clinical settings is warranted to establish its impact on survival and neurological outcomes.