Approximately 7 million people present to the emergency department (ED) due to cardiac arrest yearly [1]. Both the American Heart Association and the European Resuscitation Council emphasize minimizing the time between chest compressions cycles for the pulse check since prolonged interruptions in chest compressions are associated with decreased coronary and cerebral perfusion, lower rates of return of spontaneous circulation (ROSC), and poorer neurological outcomes [2,3]. Despite multiple studies reporting the inaccuracy and unreliability of manual palpation for pulse detection (MPC) during cardiac arrest, it is still considered the standard of care and remains the primary assessment method. Performance varies significantly based on provider experience and patient body habitus, with some reports indicating that it can take up to 30 s to accurately determine the presence or absence of a pulse. There are also reports of providers mistakenly perceiving a pulse when none was present, an error that can lead to catastrophic consequences for the patient [[4], [5], [6], [7], [8], [9]].

Over the past decade, point-of-care ultrasound (POCUS) has become a valuable and widely adopted tool in emergency medicine, including its use during cardiac arrest resuscitation to assess cardiac activity [[10], [11], [12]]. More recently, POCUS has been proposed as an alternative to manual palpation due to its reported high sensitivity and interobserver reliability [13,14]. Emerging techniques for POCUS-based pulse checks (USPC) include carotid compression methods [15,16] and Doppler ultrasound to detect arterial flow [17,18].

The objective of this systematic review was to evaluate whether POCUS reduces the duration of interruptions during resuscitation compared to manual palpation and if POCUS is a superior diagnostic tool. The primary outcome is comparing mean pulse check times between ultrasound-guided and manual methods and their sensitivity and specificity. Secondary outcomes include the frequency of prolonged pulse checks exceeding 5 and 10 s.