title: Comparison of three sites to check the pulse and count heart rate in hypotensive infants.
abstract: BACKGROUND
  Current international guidelines state that heart rate counted at the brachial pulse must be absent or <60 b x min(-1) to diagnose cardiac arrest. Some data suggest that this site may not be the best to check cardiac activity. Hypotension is a likely real scenario of the need for chest compressions in infants. We compared the performance of three sites of pulse palpation (brachial, carotid, and femoral) for detecting and counting heartbeat in hypotensive infants.
  
  
  METHODS
  In an operating theater of a pediatric teaching hospital in Italy, we studied 40 anesthetized hypotensive infants just prior to surgery, checked by two doctors and two nurses by a cross-sectional, repeated-measures study design. Each examiner, blind to the monitoring data of the patient, was asked to find the infant's arterial pulse within 10 s and count heart rate for 15 s. During each examination, the order of the three sites was randomized.
  
  
  RESULTS
  Among successful detections, femoral pulse palpation resulted as the most successful, rapid, and accurate site to detect and count heart rate in hypotensive infants.
  
  
  CONCLUSIONS
  Femoral palpation proved to be the best site for detecting heartbeat and counting heart rate in hypotensive infants. These findings challenge the current guidelines. More data are needed, but the current standard of brachial pulse assessment is debatable.
authors.affiliation: Department of Anaesthesia and Intensive Care, IRCCS Istituto per l'Infanzia Burlo Garofolo, Trieste, Italy. sarti@burlo.trieste.it
authors.forename: Armando
authors.initials: A
authors.lastname: Sarti
authors.forename: Fabio
authors.initials: F
authors.lastname: Savron
authors.forename: Luca
authors.initials: L
authors.lastname: Ronfani
authors.forename: Gloria
authors.initials: G
authors.lastname: Pelizzo
authors.forename: Egidio
authors.initials: E
authors.lastname: Barbi
mesh_terms: D000375:Aging / Q000502:physiology; D001916:Brachial Artery / Q000502:physiology; D002339:Carotid Arteries / Q000502:physiology; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D005263:Femoral Artery / Q000502:physiology; D006323:Heart Arrest / Q000175:diagnosis; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000151:congenital / Q000175:diagnosis* / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016343:Monitoring, Intraoperative; D010173:Palpation; D011446:Prospective Studies; D011674:Pulse / Q000379:methods*