An interventional study of Transesophageal Echocardiography-Guided Chest Compression and Conventional Cardiopulmonary Resuscitation in Out-of-hospital Cardiac Arrest (OHCA), sponsored by Far Eastern Memorial Hospital. Not yet recruiting at 1 site in Taiwan. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-11-02.
Sponsored by Far Eastern Memorial Hospital · Not applicable, Interventional, and Treatment
Out-of-hospital cardiac arrest (OHCA) remains a major global public health challenge. Despite continuous advancements in resuscitation strategies, overall survival rates remain low. High-quality chest compressions are the cornerstone of cardiopulmonary resuscitation, and current guidelines recommend compressions over the lower half of the sternum. However, accumulating evidence suggests that compressions at this location may result in aortic valve compression in approximately half of patients, impairing valve opening and obstructing forward blood flow from the heart, thereby diminishing resuscitation effectiveness. Both animal and human studies have consistently demonstrated a significant inverse association between aortic valve compression and survival outcomes. Transesophageal echocardiography (TEE) enables real-time visualization of cardiac structures during ongoing chest compressions and can guide adjustment of the compression site to avoid aortic valve compression. The study team previously conducted an in-hospital randomized clinical trial of TEE-guided CPR (EXECT-CPR-1). Although improvements in physiologic indicators were observed, no statistically significant improvement in clinical outcomes was demonstrated. These findings support further investigation of whether earlier initiation of TEE-guided CPR in the prehospital setting can improve clinical outcomes. To evaluate this hypothesis, the present randomized clinical trial (EXECT-CPR-2) will leverage the nation's first prehospital physician rapid response system, in which physician-led teams are directly dispatched by the dispatch center to the scene of cardiac arrest. This approach aims to shift the initiation of TEE-guided intervention from the in-hospital to the prehospital phase. The study hypothesis, structured using the P-I-C-O framework, is that among patients with OHCA (P), those who receive prehospital TEE-guided chest compressions designed to avoid aortic valve compression (I), compared with conventional chest compressions over the lower half of the sternum (C), will achieve higher rates of return of spontaneous circulation (O), survival, and favorable neurological outcomes. A total of 204 patients will be enrolled over an estimated three-year period. This trial is expected to provide critical evidence to advance precision resuscitation medicine.
Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge, and high-quality chest compressions are among the most important determinants of successful resuscitation. Current resuscitation guidelines recommend chest compressions over the lower half of the sternum. However, the anatomical relationship between the sternum and the cardiac structures varies among patients. In some patients, standard chest compressions may compress the aortic valve, left ventricular outflow tract, or aortic root, potentially impairing forward blood flow during cardiopulmonary resuscitation (CPR). Transesophageal echocardiography (TEE) allows continuous visualization of the heart during CPR without interrupting chest compressions. Previous observational studies and experimental data suggest that the optimal compression site may differ between patients, and that TEE-guided adjustment of the compression site to avoid aortic valve compression may improve hemodynamic quality during CPR. The study team previously conducted an in-hospital randomized clinical trial evaluating TEE-guided CPR in patients with non-traumatic OHCA. Although in-hospital TEE-guided CPR improved physiologic indicators such as end-tidal carbon dioxide after adjustment of the compression site, the intervention may have occurred too late to substantially change clinical outcomes. These findings support the hypothesis that earlier, prehospital application of TEE-guided CPR may be required to influence resuscitation outcomes. This trial, named EXECT-CPR-2, is designed to evaluate whether prehospital TEE-guided CPR can improve resuscitation for adult patients with non-traumatic OHCA. The trial will be conducted through a physician response unit, also referred to as a Doctor Car system, jointly operated by Far Eastern Memorial Hospital and the New Taipei City Fire Department. When a suspected OHCA case meets the dispatch criteria during the service period, a conventional ambulance and the physician response unit will be dispatched to the scene. The physician response unit includes an emergency physician trained in resuscitative TEE and other trained emergency medical personnel, and carries a portable TEE device to the prehospital scene. All patients will receive standard prehospital advanced life support according to local EMS protocols. After arrival at the scene and initial eligibility assessment, endotracheal intubation will be performed if not already established by EMS personnel. For patients who have already been intubated by paramedics before the physician response unit arrives, proper endotracheal tube placement and adequate ventilation will be confirmed without requiring repeat intubation. Only patients with confirmed endotracheal intubation and adequate ventilation will be eligible for randomization. Eligible patients will then be randomized on-site in a 1:1 ratio using the REDCap electronic randomization system. Patients assigned to the TEE-guided CPR group will undergo real-time TEE assessment during ongoing CPR. TEE will be used to identify the area of maximal compression and assess its relationship to the aortic valve and surrounding cardiac structures. If the initial compression site results in compression of the aortic valve, left ventricular outflow tract, or aortic root, the chest compression site will be adjusted under TEE guidance to avoid compression of these structures. Once the preferred compression site is identified, it will be marked on the patient's body surface to guide subsequent CPR. Patients assigned to the conventional CPR group will not undergo TEE examination. Chest compressions will be performed according to the standard guideline-recommended position. After prehospital management, patients will be transported to Far Eastern Memorial Hospital for continued resuscitation and post-arrest care when indicated. In-hospital treatment, including extracorporeal cardiopulmonary resuscitation, coronary intervention, targeted temperature management, and intensive care, will follow institutional protocols and the treating team's clinical judgment. Because of the time-sensitive nature of prehospital cardiac arrest resuscitation, some exclusion criteria may only be identified or become applicable after randomization. Participants who meet any of the prespecified exclusion criteria after randomization will be excluded from the analysis in accordance with the study protocol. All post-randomization exclusions and their reasons will be documented and reported separately for each study group. The purpose of this trial is to determine whether initiating individualized TEE-guided CPR at the prehospital stage, compared with conventional CPR, can improve the effectiveness of CPR and subsequent resuscitation outcomes in patients with non-traumatic OHCA.
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 204 is close to the median of 218 across 179 interventional studies indexed under Out-of-Hospital Cardiac Arrest.
Browse Out-of-Hospital Cardiac Arrest studies →Far Eastern Memorial Hospital is the lead sponsor of 260 studies on the registry; 40 are open to participants now.
Counted across the registry records on this site, refreshed daily.
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Participants must meet all of the following criteria:
Exclusion Criteria
Participants meeting any of the following criteria will be excluded:
The patient has to TEE, including:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Contraindication
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Participants will receive standard prehospital and in-hospital cardiopulmonary resuscitation. Transesophageal echocardiography will be performed during resuscitation. Real-time TEE imaging will be used to guide chest compression positioning to avoid compression of the aortic valve and adjacent cardiac structures.
Procedure: Transesophageal Echocardiography-Guided Chest Compression
Participants will receive standard prehospital and in-hospital cardiopulmonary resuscitation. Chest compressions will be performed according to standard resuscitation protocols without transesophageal echocardiography (TEE) guidance. All other prehospital and in-hospital resuscitation care will follow standard clinical protocols.
Procedure: Conventional Cardiopulmonary Resuscitation
During CPR, a physician will perform transesophageal echocardiography to obtain real-time cardiac images. The images will be used to identify the area of maximal compression and assess whether chest compressions are compressing the aortic valve, left ventricular outflow tract, or aortic root. If compression of these structures is identified, the chest compression site will be adjusted under TEE guidance to avoid compression of these structures. All other prehospital and in-hospital resuscitation care will follow standard clinical protocols.
Also known as: TEE-Guided CPR
During cardiopulmonary resuscitation, chest compressions will be performed according to standard resuscitation protocols without TEE guidance. Transesophageal echocardiography will not be performed during CPR, and the chest compression position will not be adjusted based on echocardiographic findings. All other prehospital and in-hospital resuscitation care will follow standard clinical protocols.
Also known as: Conventional CPR, Standard CPR
Any Return of Spontaneous Circulation
Number and percentage of participants who achieve return of spontaneous circulation, defined as the presence of a palpable pulse lasting for at least 1 minute, regardless of whether it occurs before or after hospital arrival.
Time frame: up to 1 day
Sustained Return of Spontaneous Circulation
Number and percentage of participants who achieve sustained return of spontaneous circulation, defined as the presence of a palpable pulse lasting for at least 20 consecutive minutes, regardless of whether it occurs before or after hospital arrival.
Time frame: up to 1 day
Prehospital Return of Spontaneous Circulation
Number and percentage of participants who achieve return of spontaneous circulation before hospital arrival, defined as the presence of a palpable pulse lasting for at least 1 minute before arrival at the emergency department.
Time frame: up to 1 day
Survival With Spontaneous Circulation at Emergency Department Arrival
Number and percentage of participants who achieve return of spontaneous circulation before hospital arrival and retain spontaneous circulation at the time of arrival at the emergency department.
Time frame: up to 1 day
Survival to Intensive Care Unit Admission
Number and percentage of participants who achieve return of spontaneous circulation, remain sufficiently stable after emergency department resuscitation, and are admitted to an intensive care unit.
Time frame: up to 1 month
Survival at 30 days
The number and proportion of patients who are alive 30 days after enrollment will be recorded and compared between the TEE-guided CPR group and the conventional CPR group.
Time frame: 1 month
Survival to Hospital Discharge
Number and percentage of participants who survive the index hospitalization and are discharged alive to home, a rehabilitation facility, or another long-term care setting.
Time frame: up to 1 year
Favorable Neurological Outcome at Hospital Discharge
Number and percentage of participants with a favorable neurological outcome at hospital discharge, defined as a Cerebral Performance Category score of 1 or 2.
Time frame: up to 1 year
Achieving EtCO₂ ≥20 mmHg During Prehospital CPR
The proportion of participants who achieve an end-tidal carbon dioxide (EtCO₂) level of ≥20 mmHg at least once during prehospital CPR after randomization, based on valid capnography measurements.
Time frame: up to 1 day
EtCO₂ trend during CPR
End-tidal carbon dioxide (EtCO₂), measured in mmHg, will be recorded at 1-minute intervals during ongoing prehospital and in-hospital CPR, beginning after randomization. The time of emergency call receipt by the EMS dispatch center will be defined as time zero. Measurements will be included until return of spontaneous circulation (ROSC) or termination of resuscitation. EtCO₂ values will be aligned according to elapsed time from emergency call receipt and displayed as group-level trend graphs to compare the TEE-guided CPR and conventional CPR groups.
Time frame: up to 1 day
TEE- and CPR-related adverse events
TEE- and CPR-related adverse events will be recorded and compared between groups. Events include suspected or confirmed oropharyngeal, esophageal, or gastric perforation; clinically important upper gastrointestinal bleeding requiring hemostatic intervention; airway dislodgement or ventilation difficulty related to TEE insertion; clinically significant interruption of chest compressions related to TEE; rib fracture, pneumothorax, hemothorax, or other CPR-related traumatic injury; and any other adverse event judged by the investigators to be related to TEE or CPR.
Time frame: up to 1 year
Plan to share: No — Individual participant data will not be shared because the study involves sensitive emergency medical information, including prehospital resuscitation records, transesophageal echocardiography images, and audiovisual data. Data sharing is not included in the current ethics approval or informed consent framework. Study findings will be reported in aggregate form to protect participant privacy and confidentiality.
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 ↗
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