Peripheral pULSe Assessment and Arterial pRessure (PULSAR)

Официальное название

Association Between Palpable Peripheral Pulses and Arterial Blood Pressure in Patients With Circulatory Shock: An International Prospective Multicenter Observational Cohort Study

Обзор

This prospective multicenter observational study aims to investigate the relationship between palpable peripheral pulses and simultaneously measured arterial blood pressure in adult patients with circulatory shock or impending circulatory failure. Peripheral pulse palpation is routinely used in emergency medicine, trauma care, critical care, and cardiopulmonary resuscitation as a rapid clinical assessment of circulation. However, the association between palpable pulses and actual arterial blood pressure remains poorly validated. Patients treated in emergency departments, intensive care units, operating rooms, and other acute care settings will undergo routine pulse palpation at predefined anatomical locations including carotid, femoral, and radial arteries. Simultaneously measured non-invasive and/or invasive arterial blood pressure values will be recorded from routine clinical monitoring systems. Additional clinical variables relevant to circulatory status will also be collected. The study seeks to define blood pressure thresholds associated with pulse palpability and evaluate the agreement between invasive and non-invasive blood pressure measurements in patients with circulatory shock.

Подробное описание

The presence or absence of palpable peripheral pulses is widely used as a rapid bedside indicator of circulatory status during trauma care, emergency medicine, intensive care, and cardiopulmonary resuscitation. Advanced Trauma Life Support (ATLS) teaching traditionally assumes that palpable pulses at different anatomical sites correspond to specific systolic blood pressure thresholds. However, these assumptions are based on limited evidence from small observational studies.

This international multicenter prospective observational cohort study aims to investigate the relationship between palpable carotid, femoral, and radial pulses and simultaneously measured arterial blood pressure in adult patients with circulatory shock or impending circulatory failure.

Patients receiving routine hemodynamic monitoring with non-invasive blood pressure (NIBP) and/or invasive arterial blood pressure (IBP) monitoring will be included. Pulse palpation will be performed during routine clinical care without altering treatment or management.

The primary objective is to determine the association between pulse palpability and measured systolic blood pressure. Secondary objectives include identifying blood pressure thresholds associated with pulse palpability, evaluating agreement between invasive and non-invasive blood pressure measurements, and assessing whether patient factors such as vascular disease or vasoactive medication use influence pulse palpability.

Вмешательства

• Процедура Peripheral Pulse Palpation
  Manual palpation of carotid, femoral, and radial pulses performed during routine clinical care in patients with circulatory instability. Simultaneous arterial blood pressure measurements are recorded from standard monitoring systems. No study-specific treatment or intervention is administered.

Первичные конечные точки

• Association between palpable pulses and systolic arterial blood pressure [Срок оценки: During episodes of circulatory instability, up to 24 hours after inclusion]

Вторичные конечные точки (3)

• Mean arterial pressure associated with pulse palpability [Срок оценки: During episodes of circulatory instability, up to 24 hours after inclusion]
• Agreement between non-invasive and invasive blood pressure measurements [Срок оценки: During episodes of circulatory instability, up to 24 hours after inclusion]
• Effect of vascular disease and vasoactive medication on pulse palpability [Срок оценки: During hospital admission, up to 30 days]

Критерии участия

Критерии включения

• Clinical signs of circulatory shock or impending circulatory failure
• Availability of non-invasive and/or invasive arterial blood pressure monitoring
• Pulse palpation possible without interfering with emergency care

Критерии исключения

• Peripheral vascular conditions preventing reliable pulse palpation
• Major extremity amputation affecting assessment sites
• Clinical situations where study procedures interfere with life-saving treatment

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Швеция · 1 центр

• Region Stockholm, all hospitals — Stockholm

Публикации

• Gunther M, Dahlberg M, Rostami A, Azadali A, Arborelius UP, Linder F, Rostami E. Incidence, Demographics, and Outcomes of Penetrating Trauma in Sweden During the Past Decade. Front Neurol. 2021 Nov 15;12:730405. doi: 10.3389/fneur.2021.730405. eCollection 2021. PMID 34867718
• Kim SH, Lilot M, Sidhu KS, Rinehart J, Yu Z, Canales C, Cannesson M. Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: a systematic review and meta-analysis. Anesthesiology. 2014 May;120(5):1080-97. doi: 10.1097/ALN.0000000000000226. PMID 24637618

Идентификаторы

NCT: NCT07609095 · 2026-02475-01

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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