Why Lay Rescuers Don't Check a Pulse

It wasn’t that long ago when lay responders were expected to check the carotid pulse on a victim of cardiac arrest before starting CPR. If you couldn't detect a pulse then you would start CPR.

The problem was this seemingly simple step was causing uncertainty and delays in starting CPR. After research showed how few people could successfully do it, the step was dropped from lay rescuer CPR training in 2005.

The check pulse gave way to a check for responsiveness and breathing. For healthcare providers such as EMTs and paramedics, the pulse step has been de-emphasized. Why?

Determining Pulse Not Easy

As easy as checking a pulse sounds, researchers have found many nurses and paramedics have trouble accurately detecting a pulse by palpation (touch). Studies have shown both lay rescuers and healthcare professionals have difficulty detecting a pulse.1 In addition, it takes too long for them to check it. This delays the start of vital chest compressions and defibrillation.

To determine if someone is in cardiac arrest, you must tap and shout and look to see if the victim is not breathing normally. The words "breathing normally" are key. You want to be aware of agonal breaths which occur in as many as half of all sudden cardiac arrests.2

Gasping or agonal breaths are not normal breathing. These sporadic, gasping breaths are sometimes seen in cardiac arrest because the respiratory center of the brain continues to send signals to the respiratory muscles. They soon cease.

Responsiveness and breathing are reliable signs of cardiac arrest that lay responders can learn quickly. They are accurate signs of cardiac arrest and are easier to teach than feeling for a pulse.

References

1. Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, Lerner EB, Rea TD, Sayre MR, Swor RA. Part 5: Adult Basic Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122;S685-S705

2. Eisenberg MS. Resuscitate: How Your Community Can Improve Survival from Sudden Cardiac Arrest. Seattle: U. of Washington Press; 2009.