CPR w/pulse

In our Paramedic class, a discussion emerged on when to begin adult CPR... before or after the pulse is lost

The students stated that it was cut and dry -- According to AHA
guidelines, compressions are started when there is no palpable carotid pulse.  

The doctor proposed this situation -- You have an adult male with a weak and thready carotid pulse and a BP of 50-60/palp (no pulse rate was given).  

Is that enough of a pressure to adequately perfuse oxygen to the tissues?  May compressions be added to your list of treatments in order to circulate oxygen to the cells? Is there documentation either way stating why (or why not) you would do compressions in this scenario?  Looking forward to your thoughts.

[CCF CARDIO MD JMF]

Dear David,

We are probably more aggressive an institue CPR without a femoral pulse or if a thready inadequate pulse exists with an unstable rhythm.  There is no documentation to say which way is correct.  

We believe that in this situation additional cardiac output is a good thing.