title: A comparison of five techniques for detecting cardiac activity in infants.
abstract: BACKGROUND
  The new guidelines for cardiopulmonary resuscitation recommend that laypersons should begin chest compressions without checking for a pulse because the pulse check has serious limitations in accuracy. We determined the efficacy of the most suitable method to search for cardiac activity in infants.
  
  
  METHODS
  Twenty-eight nurses tried to detect infants' cardiac activity and determined their heart rates with five different techniques: palpation of brachial pulse, carotid pulse, femoral pulse, apical impulse and auscultation of apical impulse with the naked ear (direct auscultation technique).
  
  
  RESULTS
  The mean time interval required to find the pulse within 30 s in the auscultation, the apical, the brachial, the carotid and the femoral were 2.4 +/- 1.2, 3.5 +/- 2.7, 4.0 +/- 2.7, 9.9 +/- 7.0 and 9.1 +/- 5.9 s, respectively. The required time was significantly shorter in the auscultation method than in the palpation of carotid and femoral pulses. The percentage and 95% confidence intervals (95% CI) of pulses identified within 10 s (= the number of the correct identified within 10 s/the number of all cases) in auscultation, apical, brachial, carotid and femoral palpations were 100.0% (95% CI 51.8, 100), 75.0% (95% CI 28.9, 89.3), 73.1% (95% CI 52.2, 88.4), 50.0% (95% CI 30.6, 69.4) and 42.9% (95% CI 24.5, 62.8), respectively. These values were greater in the auscultation method than in all the palpation methods.
  
  
  CONCLUSIONS
  The direct auscultation technique was more rapid and accurate than any other techniques to determine cardiac activity without instruments. It is suggested that direct a auscultation technique is also superior to the palpation of brachial artery in cardiopulmonary resuscitation in infants.
authors.affiliation: Department of Anesthesia, Kanagawa Children's Medical Center, Yokohama 236-0004, Japan. inagawa@med.yokohama-cu.ac.jp
authors.forename: Gaku
authors.initials: G
authors.lastname: Inagawa
authors.forename: Naoto
authors.initials: N
authors.lastname: Morimura
authors.forename: Takaaki
authors.initials: T
authors.lastname: Miwa
authors.forename: Koji
authors.initials: K
authors.lastname: Okuda
authors.forename: Masako
authors.initials: M
authors.lastname: Hirata
authors.forename: Koichi
authors.initials: K
authors.lastname: Hiroki
mesh_terms: D001916:Brachial Artery / Q000502:physiology; D016887:Cardiopulmonary Resuscitation; D002339:Carotid Arteries / Q000502:physiology; D005263:Femoral Artery / Q000502:physiology; D006326:Heart Auscultation; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007223:Infant; D010173:Palpation; D011674:Pulse / Q000379:methods*; D013997:Time Factors