An interventional study of Fixed PEEP Valve and Sham Valve in Cardiac Arrest, Out-Of-Hospital, sponsored by Jeroen van Eijk. Active, not recruiting at 3 sites in Netherlands. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-10-29.
Sponsored by Jeroen van Eijk · Not applicable, Interventional, and Treatment
The goal of this clinical trial is to learn if applying positive end-expiratory pressure (PEEP) during cardiopulmonary resuscitation (CPR) improves neurological outcome in adults with out-of-hospital cardiac arrest who receive an advanced airway (supraglottic airway device or endotracheal tube). The main question it aims to answer is:
Does ventilating with 8 cm H2O PEEP during CPR improve neurological outcome at hospital discharge, as measured by the utility-weighted modified Rankin Scale (UW-mRS)?
Researchers will compare an 8 cm H2O PEEP valve to a look-alike sham valve that provides no PEEP (zero end-expiratory pressure) to see if PEEP improves neurological outcome.
Participants will:
Rationale Cardiopulmonary resuscitation (CPR) aims to provide oxygen to vital organs through chest compressions and ventilations, until return of spontaneous circulation (ROSC) is achieved. A major barrier to effective oxygenation during CPR is atelectasis, which impairs gas exchange and results in hypoxemia-a condition strongly associated with decreased rates of ROSC and worsened neurological outcomes.
Positive end-expiratory pressure (PEEP) is routinely used in critical care to prevent atelectasis and improve oxygenation. During CPR, however, its use is inconsistent and subject of debate. This reflects long-standing theoretical concerns that PEEP may reduce venous return, lower cardiac output, and impair the chances of successful defibrillation. However, emerging experimental and observational data suggest that PEEP may actually improve oxygenation, cardiac output, oxygen delivery, and rates of ROSC during CPR.
We hypothesize that applying PEEP during CPR improves neurologically favorable survival. Given its simplicity, negligible cost, and widespread availability, PEEP has the potential to enhance outcomes from cardiac arrest in a scalable and resource-efficient manner.
Objective To determine whether, during CPR with manual ventilation and after placement of a supraglottic airway device (SAD) or endotracheal tube (ETT), using a valve that generates 8 cm H₂O PEEP compared with a sham valve providing zero end-expiratory pressure (ZEEP) improves neurological outcomes at discharge.
Study design The REVIVE-PEEP study is an investigator-initiated, pragmatic, registry-based, multicenter, parallel-group, triple-blind randomized controlled superiority clinical trial in the ARREST registry.
Study population The principal stratum comprises adult patients with out-of-hospital cardiac arrest (OHCA) in whom advanced airway management is performed, defined by placement of a SAD or ETT, who subsequently undergo manual positive-pressure ventilation during CPR. The target sample size within this principal stratum is 2,400 patients.
Intervention Participating ambulance services will use pre-assembled CPR kits, containing a bag-valve-mask system with either a PEEP valve or a sham valve. These kits will be 1:1 pre-randomized, with the PEEP valve delivering 8 cm H₂O of PEEP and the sham valve delivering 0 cm H₂O of PEEP (i.e. ZEEP), alongside the standard advanced life support protocol.
Main study parameters/endpoints The primary estimand is the treatment effect on neurological outcome at hospital discharge, assessed by the utility-weighted modified Rankin Scale within the principal stratum. Key secondary outcomes include ROSC, 30-day survival and quality of life at 6 months.
314 studies on the registry are indexed under Out-of-Hospital Cardiac Arrest; 93 are open to participants now.
This study's planned enrollment of 3,200 is above the median of 218 across 179 interventional studies indexed under Out-of-Hospital Cardiac Arrest.
Browse Out-of-Hospital Cardiac Arrest studies →Jeroen van Eijk is the lead sponsor of 2 studies on the registry; 1 is open to participants now.
Counted across the registry records on this site, refreshed daily.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
8 cm H2O of PEEP
Device: Fixed PEEP Valve
Device: Sham Valve
8 cm H2O
0 cm H2O of PEEP
Also known as: ZEEP
Neurological outcomes
uw-mRS
Time frame: At hospital discharge (up to 30 days after the cardiac arrest)
Plan to share: Undecided
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
This study is active, not recruiting, as verified in Oct 2026. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Out-of-Hospital Cardiac Arrest →
Jeroen van Eijk