title: Heartbeat assessment in infants: a comparison of four clinical methods.
abstract: OBJECTIVE
  To compare the performance of four clinical methods (apex ear auscultation; brachial, carotid, and femoral pulse palpation) for detecting and counting heart beat in infants.
  
  
  METHODS
  Cross-sectional, repeated-measures study design. Prospective data collection.
  
  
  METHODS
  A postanesthesia care unit of a pediatric teaching hospital in Italy.
  
  
  METHODS
  Fifty-six normotensive sedated infants, aged 1-12 mos, were evaluated by 14 pediatric basic life support (PBLS)-qualified health professionals.
  
  
  METHODS
  None.
  
  
  RESULTS
  The proportion of successful heartbeat detections ranged from 60% with carotid pulse palpation to 98% with apex auscultation. Among successful detections, apex auscultation proved to be the most rapid way to detect heart rate (median, 4 secs) and the most accurate with a median discrepancy of 8 beats/min (vs. 12 with the other methods) from the electrocardiographic results. Differences between apex auscultation and pulse palpation were statistically significant (p < .0001). In contrast, no significant differences were found among the three methods of pulse checking.
  
  
  CONCLUSIONS
  Apex listening is the most successful, rapid, and accurate method to detect and count the heartbeat by PBLS-certified professionals in normotensive infants without instruments. Pulse checking remains important for assessing the effectiveness of circulation. Palpating the brachial, carotid, or femoral pulse is equally effective.
authors.affiliation: Department of Anaesthesia and Intensive Care, IRCCS Istituto per l'Infanzia Burlo Garofolo, Trieste, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Sarti
authors.forename: Fabio
authors.initials: F
authors.lastname: Savron
authors.forename: Veronica
authors.initials: V
authors.lastname: Casotto
authors.forename: Marina
authors.initials: M
authors.lastname: Cuttini
mesh_terms: D001158:Arteries / Q000502:physiology; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D006326:Heart Auscultation; D006339:Heart Rate; D006801:Humans; D007223:Infant; D010173:Palpation; D011446:Prospective Studies; D011674:Pulse; D015203:Reproducibility of Results; D013997:Time Factors