Hands-free carotid ultrasound improves ROSC detection in cardiac arrest

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Resuscitation Published May 1, 2026 Medically reviewed May 1, 2026 Study authors: Li Yangyang, Xie Miaorong, Wang Guoxing, Wu Shanshan, Mi Yuhong, Zhang Jian, Han Zhen, Pu Lianmei, Z… PubMed ↗ DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider CADFlow as an adjunct for faster ROSC detection, but note the primary outcome did not reach statistical significance.

This randomized controlled trial enrolled 341 adult patients with in-hospital cardiac arrest across five affiliated teaching hospitals. Patients were assigned to either hands-free carotid ultrasound (CADFlow) or manual palpation of the carotid artery to guide resuscitation.

The primary outcome of ROSC success rate was non-significantly higher in the CADFlow group, with a 10-percentage-point absolute increase (43% vs. 33%, P=0.053). However, the mean time required to assess carotid pulsation was significantly shorter with CADFlow: 2.9 (SD 0.8) seconds versus 7.2 (SD 1.3) seconds (P<0.001). Secondary outcomes included chest compression parameters and carotid blood flow relationships, but detailed results were not reported.

Safety data, including adverse events, serious adverse events, and discontinuations, were not reported. Limitations of the study were not explicitly stated, and funding or conflicts of interest were not disclosed. The follow-up duration was also not reported.

Clinically, CADFlow may offer faster and more accurate ROSC detection and real-time feedback for CPR quality optimization. However, the lack of statistical significance for the primary outcome and unreported safety data warrant cautious interpretation. Further studies are needed to confirm these findings and assess clinical outcomes.

Study Details

Study typeRct

EvidenceLevel 2

PublishedMay 2026

PMID41720426

View Original Abstract ↓

OBJECTIVE: This study investigated the effectiveness and accuracy of hands-free carotid ultrasound (CADFlow, Continuous Auto Doppler Flow, Sensus Medical, Suzhou, China) for monitoring carotid blood flow in assessing the return of spontaneous circulation (ROSC), in comparison to manual palpation of major arterial pulses. METHODS: A total of 341 adult patients with in-hospital cardiac arrest were enrolled from five affiliated teaching hospitals of medical universities. Chest compression rate and depth were monitored using the Prehospital Advanced Life Support Manual Cardiopulmonary Resuscitation (PALMCPR, SunLife Science, Suzhou, China) system. In the CADFlow group, hands-free carotid ultrasound was used to monitor carotid pulsation, while the control group relied on manual palpation of the carotid artery to assess ROSC. The groups were compared in terms of ROSC success rates, time to ROSC determination, and ROSC misjudgment rates. Additionally, the relationships between chest compression parameters (depth and rate) and carotid blood flow were analyzed. RESULTS: The ROSC success rate was non-significantly higher in the CADFlow group than in the control group (43% vs. 33%, P = 0.053), corresponding to a 10-percentage-point absolute increase The mean time required to assess carotid pulsation was significantly shorter in the CADFlow group (2.9 (SD 0.8) s vs. 7.2 (SD 1.3) s, P < 0.001). Strong correlations were observed between chest compression depth and CADFlow parameters, suggesting that the system can effectively assess Cardiopulmonary Resuscitation (CPR) compression quality. CONCLUSIONS: The CADFlow hands-free carotid Doppler ultrasound system improves ROSC detection, shortens assessment time, and provides real-time feedback for CPR quality optimisation. TRIAL REGISTRATION: This clinical trial is registered with the Chinese Clinical Trial Registry (ChiCTR), with the registration number ChiCTR2200064633. The trial was registered on October 13, 2022. The full trial protocol is available upon request from the corresponding author.