Determining the Pulse for Infant Cardiopulmonary Resuscitation: Time for a Change?

Lee CJ, Bullock LJ Military Medicine 1991 Vol 56 Pages 190-193

The accepted standard for determining cardiac arrest in infants is the use of palpation of the brachial pulse in infants. The investigators have observed that CPR-certified individuals have difficulty locating the brachial pulse in infants. Therefore, the purpose of this study was to determine if a more effective way existed for assessing the pulse in an infant. In the 102 CPR-certified individuals tested, mean age was 32.2 years (range 16-70 years) with 53 women and 51 men in the sample. 84/102 correctly assessed the apical pulse by placing a naked ear against the chest wall, whereas only 48 correctly palpated the brachial pulse. 70% of the subjects preferred the apical method, while only 22% preferred the brachial method, and 8% expressed no preference. The median and mean times to correctly locate and ascertain the infants pulse rate while using the brachial method were 7.0 and 11.22 seconds respectively, while the apical method times were 2.75 and 3.14 seconds. The study results demonstrated that there was a statistically significant (p<0.001) difference between the two methods for assessing pulses in infants. This indicates that the apical pulse method is a faster and more accurate method for locating the pulse in an infant, and should be used during cardiopulmonary resuscitation.