Circulatory ShockPULSARNCT07609095
Peripheral pULSe Assessment and Arterial pRessure (PULSAR)
An observational study of Circulatory Shock and Hemodynamic Instability, run by Region Stockholm at 1 site in Sweden.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Circulatory Shock, Hemodynamic Instability, Hypotension
- What is being tested?
- Peripheral Pulse Palpation
- Type of treatment
- Surgery or procedure
- How many people
- 5,000 participants
- Where
- 1 siteSweden
- Study dates
- 1 Jun 2026to 31 Dec 2031
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Adult patients with circulatory shock or impending circulatory failure treated in emergency departments, intensive care units, operating rooms, trauma centers, and other acute care settings.
Who may be able to join
- 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
Who cannot join
- Peripheral vascular conditions preventing reliable pulse palpation
- Major extremity amputation affecting assessment sites
- Clinical situations where study procedures interfere with life-saving treatment
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Sweden1 site, 1 recruiting
- Recruiting
Region Stockholm, all hospitals
Stockholm, Stockholm County, 11883
Mattias Günther, MD PhD, 46812361000, mattias.gunther@ki.se
About this study
Official title: Association Between Palpable Peripheral Pulses and Arterial Blood Pressure in Patients With Circulatory Shock: An International Prospective Multicenter Observational Cohort Study
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.
Read the detailed description
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.
- Conditions
- Circulatory Shock, Hemodynamic Instability, Hypotension, Shock, Critical Illness
- Being tested
- Peripheral Pulse Palpation
- Keywords
- Circulatory Shock, Hemodynamic Monitoring, Pulse Palpation, Peripheral Pulse, Arterial Blood Pressure, Hypotension, Critical Care, Trauma, Resuscitation, Hemodynamic Instability
- Medical subject headings
- Shock, Hypotension, Critical Illness, Wounds and Injuries
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Peripheral Pulse PalpationProcedure or surgery
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.
| Study group | Role | What they receive |
|---|---|---|
| Patients With Circulatory Shock | Adult patients with clinical signs of circulatory shock or impending circulatory failure undergoing routine hemodynamic monitoring with non-invasive and/or invasive arterial blood pressure measurement during standard clinical care. Receives: Procedure: Peripheral Pulse Palpation |
What is being measured
The primary outcome is the main question the study is designed to answer.
Association between palpable pulses and systolic arterial blood pressure
Relationship between palpable carotid, femoral, and radial pulses and simultaneously measured systolic arterial blood pressure.
Measured: During episodes of circulatory instability, up to 24 hours after inclusion
Secondary outcomes (3)
Mean arterial pressure associated with pulse palpability
Relationship between pulse palpability and mean arterial pressure (MAP).
Measured: During episodes of circulatory instability, up to 24 hours after inclusion
Agreement between non-invasive and invasive blood pressure measurements
Agreement between oscillometric non-invasive blood pressure and invasive arterial blood pressure measurements.
Measured: During episodes of circulatory instability, up to 24 hours after inclusion
Effect of vascular disease and vasoactive medication on pulse palpability
Influence of peripheral vascular disease, atherosclerosis, age, and vasoactive medications on pulse palpability.
Measured: During hospital admission, up to 30 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 May 2026
- Study start1 Jun 2026
- Primary completion1 Jun 2031 (estimated)
- Study completion31 Dec 2031 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Circulatory ShockStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 5,000 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Region Stockholm
- Sponsor type
- Other government
- Responsible party
- Principal investigator, Mattias Gunther, Region Stockholm
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07609095
- Sponsor's protocol ID
- 2026-02475-01
- Acronym
- PULSAR
- Status last verified
- Aug 2026
- First submitted
- 13 May 2026
- Last updated
- 18 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided: Data sharing plans are currently undecided due to ongoing considerations regarding ethical approvals, multicenter collaboration agreements, and data protection regulations.
Publications
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.
PubMed 34867718Kim 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.
PubMed 24637618
Study at a glance
From the registry record, last updated by the sponsor on 18 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Association Between Palpable Peripheral Pulses and Arterial Blood Pressure in Patients With Circulatory Shock: An International Prospective Multicenter Observational Cohort Study
- ClinicalTrials.gov ID
- NCT07609095
- Acronym / sponsor ID
- PULSAR / 2026-02475-01
- Conditions
- Circulatory Shock, Hemodynamic Instability, Hypotension, Shock, Critical Illness
- Keywords
- Circulatory Shock, Hemodynamic Monitoring, Pulse Palpation, Peripheral Pulse, Arterial Blood Pressure, Hypotension, Critical Care, Trauma
- Study type
- Observational
- Recruitment status
- Recruiting
- Enrolment
- 5,000 participants (estimated)
- Lead sponsor
- Region StockholmOther government
- Study start
- 1 Jun 2026 (actual)
- Primary completion
- 1 Jun 2031 (estimated)
- Study completion
- 31 Dec 2031 (estimated)
- First posted
- 27 May 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
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.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Patients With Circulatory Shock | – | Procedure: Peripheral Pulse PalpationAdult patients with clinical signs of circulatory shock or impending circulatory failure undergoing routine hemodynamic monitoring with non-invasive and/or invasive arterial blood pressure measurement during standard clinical care. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Adult patients with circulatory shock or impending circulatory failure treated in emergency departments, intensive care units, operating rooms, trauma centers, and other acute care settings.
Key inclusion criteria (3 listed)
- 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
Key exclusion criteria (3 listed)
- Peripheral vascular conditions preventing reliable pulse palpation
- Major extremity amputation affecting assessment sites
- Clinical situations where study procedures interfere with life-saving treatment
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Peripheral Pulse PalpationManual 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. | Procedure or surgery | Patients With Circulatory Shock |
Primary outcome
Association between palpable pulses and systolic arterial blood pressure
Time frame: During episodes of circulatory instability, up to 24 hours after inclusion
Relationship between palpable carotid, femoral, and radial pulses and simultaneously measured systolic arterial blood pressure.
3 secondary outcomes
Mean arterial pressure associated with pulse palpability
Time frame: During episodes of circulatory instability, up to 24 hours after inclusion
Agreement between non-invasive and invasive blood pressure measurements
Time frame: During episodes of circulatory instability, up to 24 hours after inclusion
Effect of vascular disease and vasoactive medication on pulse palpability
Time frame: During hospital admission, up to 30 days
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 Aug 2026.
- Background: PubMed 34867718Gunther 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.
- Background: PubMed 24637618Kim 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.
- Individual participant dataSharing planned: Undecided. Data sharing plans are currently undecided due to ongoing considerations regarding ethical approvals, multicenter collaboration agreements, and data protection regulations.
Related trials for Circulatory Shock
Recruiting
Fluid Balance Guided by Modified Venous Excess Ultrasonography Versus Standard Care in Patients With Acute Kidney Injury Receiving Continuous Renal Replacement Therapy
AKI - Acute Kidney Injury, Fluid Balance
Not yet recruitingObservational study
Capillary Refill Time Variation to Predict Oxygen Comsumption Variation After FLuid Challenge (CARTOFL)
Critically Ill Patients, Circulatory Shock
Not yet recruitingObservational study
Hong Kong Cardiogenic Shock Initiative
Cardiogenic Shock Acute, STEMI - ST Elevation Myocardial Infarction
RecruitingObservational study
Resuscitative TEE Collaborative Registry
Cardiac Arrest, Cardiac Arrest Circulatory
RecruitingObservational study
ICU Background Early Awareness for Critical deterioratiON
Respiratory Failure, Circulatory Failure
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Circulatory Shock and Hemodynamic Instability, run by Region Stockholm at 1 site in Sweden.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 18 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Mattias Günther, MD PhD (46812361000, mattias.gunther@ki.se), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Association between palpable pulses and systolic arterial blood pressure (time frame: During episodes of circulatory instability, up to 24 hours after inclusion). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07609095, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Aug 2026; AzTrials last refreshed its copy on 26 Oct 2026.