Out-of-hospital Cardiac Arrest (OHCA)EXECT-CPR-2NCT07909642
Execution of Prehospital Transesophageal Echocardiography During Cardiopulmonary Resuscitation in Patients With Out-of-hospital Cardiac Arrest
A study testing Transesophageal Echocardiography-Guided Chest Compression and Conventional Cardiopulmonary Resuscitation in people with Out-of-hospital Cardiac Arrest (OHCA), run by Far Eastern Memorial Hospital at 1 site in Taiwan.
Trial summary
Out-of-hospital cardiac arrest (OHCA) remains a major global public health challenge. Despite continuous advancements in resuscitation strategies, overall survival rates remain low. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Out-of-hospital Cardiac Arrest (OHCA)
- What is being tested?
- Transesophageal Echocardiography-Guided Chest Compression and Conventional Cardiopulmonary Resuscitation
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 204 participants
- Where
- 1 siteTaiwan
- Study dates
- 1 Jan 2027to 31 Dec 2030
- Phase
- Interventional
- 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
Who may be able to join
- Participants must meet all of the following criteria:
- Age ≥18 years.
- Suspected out-of-hospital cardiac arrest (OHCA) as determined by the EMS dispatch center.
- Non-traumatic cause of cardiac arrest.
- The physician response unit is dispatched by the EMS dispatch center to the resuscitation scene.
Who cannot join
- Participants meeting any of the following criteria will be excluded:
- The patient is found not to have OHCA after arrival of the physician response unit.
- The patient has obvious signs of irreversible death upon arrival of the physician response unit, including decapitation, rigor mortis, livor mortis, decomposition, or other apparent signs of death.
- The family clearly expresses a wish not to attempt resuscitation, or the patient has a pre-existing Do Not Attempt Resuscitation order.
- The patient has contraindications to TEE, including:
- Failure to establish or confirm endotracheal intubation and adequate ventilation.
Show all 14Show fewer
- Massive active bleeding from the oral cavity, pharynx, esophagus, or stomach.
- Anatomical abnormalities of the oral cavity, pharynx, esophagus, or stomach caused by disease, tumor, surgery, or trauma.
- The scene condition may damage the device or endanger the rescue team, including but not limited to strong electromagnetic fields, such as high-voltage power facilities; extreme weather, such as heavy rain or snowstorm; hazardous environments, such as flooding, fire scenes, unstable buildings, major incident scenes, toxic chemical disasters, nuclear disasters, or any other scene judged unsafe by the on-scene EMS commander.
- The TEE device is not functioning properly before randomization.
- The physician assigned to the physician response unit has not been certified to perform prehospital TEE.
- The patient receives or has extracorporeal cardiopulmonary resuscitation initiated before achieving the primary outcome.
- The patient has been transported from the scene to the hospital before randomization.
- The patient has already achieved the primary outcome, return of spontaneous circulation, before randomization.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Sheng-En Chu, physician contact
Taiwan1 site
Far Eastern Memorial Hospital
New Taipei City, 220
Sheng-En Chu, Physician, +886-2-77281843, ianchu300@msn.com
About this study
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.
Read the detailed description
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.
- Conditions
- Out-of-hospital Cardiac Arrest (OHCA)
- Being tested
- Transesophageal Echocardiography-Guided Chest Compression, Conventional Cardiopulmonary Resuscitation
- Keywords
- Transesophageal Echocardiography, Cardiopulmonary Resuscitation, TEE-Guided CPR, Chest Compression, Aortic Valve Compression, Prehospital Emergency Care, Return of Spontaneous Circulation
- Medical subject headings
- Out-of-Hospital Cardiac Arrest
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Transesophageal Echocardiography-Guided Chest CompressionProcedure or surgery
Also called TEE-Guided CPR
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.
Conventional Cardiopulmonary ResuscitationProcedure or surgery
Also called Conventional CPR, Standard 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.
| Study group | Role | What they receive |
|---|---|---|
| TEE-Guided Cardiopulmonary Resuscitation | Experimental | 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. Receives: Procedure: Transesophageal Echocardiography-Guided Chest Compression |
| Conventional Cardiopulmonary Resuscitation | Active comparator | 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. Receives: Procedure: Conventional Cardiopulmonary Resuscitation |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: up to 1 day
Secondary outcomes (8)
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.
Measured: 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.
Measured: 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.
Measured: 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.
Measured: 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.
Measured: 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.
Measured: 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.
Measured: 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.
Measured: up to 1 day
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Nov 2026
- Study start1 Jan 2027 (estimated)
- Primary completion31 Dec 2029 (estimated)
- Study completion31 Dec 2030 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (12)Papers the sponsor has linked to this study.
- Other trials for Out-of-hospital Cardiac Arrest (OHCA)Studies 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
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants will be individually randomized in a 1:1 ratio to either transesophageal echocardiography (TEE)-guided cardiopulmonary resuscitation or conventional cardiopulmonary resuscitation. Both groups will receive standard prehospital and in-hospital resuscitation care, with TEE performed exclusively in the intervention group.
- Masking
- None (open label)
- Enrolment
- 204 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Far Eastern Memorial Hospital
- Sponsor type
- University, hospital or other
- Collaborators
- National Science and Technology Council, Taiwan
- Responsible party
- Principal investigator, Sheng-En Chu, Far Eastern Memorial Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07909642
- Sponsor's protocol ID
- 115113-F
- Acronym
- EXECT-CPR-2
- Status last verified
- Oct 2026
- First submitted
- 5 Jul 2026
- Last updated
- 2 Nov 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- 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.
Publications
Kleinman ME, Buick JE, Huber N, Idris AH, Levy M, Morgan SG, Nassal MMJ, Neth MR, Norii T, Nunnally ME, Rodriguez AJ, Walsh BK, Drennan IR. Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025 Oct 21;152(16_suppl_2):S448-S478. doi: 10.1161/CIR.0000000000001369. Epub 2025 Oct 22.
PubMed 41122888Wigginton JG, Agarwal S, Bartos JA, Coute RA, Drennan IR, Haamid A, Kudenchuk PJ, Link MS, Panchal AR, Pelter MM, Del Rios M, Rodriguez AJ, Perman SM, Sanko S, Kotini-Shah P, Kurz MC. Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025 Oct 21;152(16_suppl_2):S538-S577. doi: 10.1161/CIR.0000000000001376. Epub 2025 Oct 22.
PubMed 41122884Tseng BY, Yang CJ, Sun JT, Liu YT, Yadav K, Hsieh YL, Chu SE, Lee CW, Lee YK, Tsai TY. Trends in Studies on Transesophageal Echocardiography in Emergency Medicine: A Scoping Review. West J Emerg Med. 2025 May 14;26(3):469-477. doi: 10.5811/westjem.24870.
PubMed 40561981Fair J 3rd, Mallin MP, Adler A, Ockerse P, Steenblik J, Tonna J, Youngquist ST. Transesophageal Echocardiography During Cardiopulmonary Resuscitation Is Associated With Shorter Compression Pauses Compared With Transthoracic Echocardiography. Ann Emerg Med. 2019 Jun;73(6):610-616. doi: 10.1016/j.annemergmed.2019.01.018. Epub 2019 Feb 14.
PubMed 30773413Teran F, West FM, Jelic T, Taylor L, Jafry ZM, Burns KM, Owyang CG, Emt CC, Abella BS, Andrus P; On behalf ACEP Emergency Ultrasound Section and the Resuscitative TEE Collaborative Registry (rTEECoRe) Investigators. Resuscitative transesophageal echocardiography in emergency departments in the United States and Canada: A cross-sectional survey. Am J Emerg Med. 2024 Feb;76:164-172. doi: 10.1016/j.ajem.2023.11.041. Epub 2023 Nov 29.
PubMed 38086182Teran F, Prats MI, Nelson BP, Kessler R, Blaivas M, Peberdy MA, Shillcutt SK, Arntfield RT, Bahner D. Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week. J Am Coll Cardiol. 2020 Aug 11;76(6):745-754. doi: 10.1016/j.jacc.2020.05.074.
PubMed 32762909Kruit N, Ferguson I, Dieleman J, Burns B, Shearer N, Tian D, Dennis M. Use of transoesophageal echocardiography in the pre-hospital setting to determine compression position in out of hospital cardiac arrest. Resuscitation. 2025 Apr;209:110582. doi: 10.1016/j.resuscitation.2025.110582. Epub 2025 Mar 14.
PubMed 40090608Bianconi K, Hanna M, Visveswaran G, Patel R, Pompa J, Glucksman A, Cavaliere G, Steenberg M, Tagore A, Ariyaprakai N. Retrospective Review of the Image Quality of Monoplane Transesophageal Echocardiography in Prehospital Out-of-Hospital Cardiac Arrest: A Single Center Pilot Study. Prehosp Emerg Care. 2025;29(6):820-825. doi: 10.1080/10903127.2024.2411720. Epub 2024 Nov 1.
PubMed 39387637Krammel M, Hamp T, Hafner C, Magnet I, Poppe M, Marhofer P. Feasibility of resuscitative transesophageal echocardiography at out-of-hospital emergency scenes of cardiac arrest. Sci Rep. 2023 Nov 16;13(1):20085. doi: 10.1038/s41598-023-46684-x.
PubMed 37973909Catena E, Ottolina D, Fossali T, Rech R, Borghi B, Perotti A, Ballone E, Bergomi P, Corona A, Castelli A, Colombo R. Association between left ventricular outflow tract opening and successful resuscitation after cardiac arrest. Resuscitation. 2019 May;138:8-14. doi: 10.1016/j.resuscitation.2019.02.027. Epub 2019 Feb 27.
PubMed 30825552Chu SE, Huang CY, Cheng CY, Chan CH, Chen HA, Chang CH, Tsai KC, Chiu KM, Ma MH, Chiang WC, Sun JT. Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Prospective Observational Cohort Study. Crit Care Med. 2024 Sep 1;52(9):1367-1379. doi: 10.1097/CCM.0000000000006336. Epub 2024 May 23.
PubMed 38780398Chu SE, Cheng CY, Chang CJ, Ho H, Chen HA, Chan CH, Ma MH, Chang CH, Tsai KC, Chiu KM, Chen LW, Chiang WC, Sun JT. Transesophageal Echocardiography During CPR in Patients With Out-of-Hospital Cardiac Arrest: The EXECT-CPR Randomized Clinical Trial. JAMA Intern Med. 2026 May 1;186(5):557-566. doi: 10.1001/jamainternmed.2026.0102.
PubMed 41870444
Study at a glance
From the registry record, last updated by the sponsor on 2 Nov 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Execution of Prehospital Transesophageal Echocardiography During Cardiopulmonary Resuscitation in Patients With Out-of-hospital Cardiac Arrest
- ClinicalTrials.gov ID
- NCT07909642
- Acronym / sponsor ID
- EXECT-CPR-2 / 115113-F
- Conditions
- Out-of-hospital Cardiac Arrest (OHCA)
- Keywords
- Transesophageal Echocardiography, Cardiopulmonary Resuscitation, TEE-Guided CPR, Chest Compression, Aortic Valve Compression, Prehospital Emergency Care, Return of Spontaneous Circulation
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 204 participants (estimated)
- Lead sponsor
- Far Eastern Memorial HospitalUniversity, hospital or other
- Collaborators
- National Science and Technology Council, Taiwan
- Study start
- 1 Jan 2027 (estimated)
- Primary completion
- 31 Dec 2029 (estimated)
- Study completion
- 31 Dec 2030 (estimated)
- First posted
- 2 Nov 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.
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.
Detailed description
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.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Participants will be individually randomized in a 1:1 ratio to either transesophageal echocardiography (TEE)-guided cardiopulmonary resuscitation or conventional cardiopulmonary resuscitation. Both groups will receive standard prehospital and in-hospital resuscitation care, with TEE performed exclusively in the intervention group.
| Arm | Type | Receives |
|---|---|---|
| TEE-Guided Cardiopulmonary Resuscitation | Experimental | Procedure: Transesophageal Echocardiography-Guided Chest CompressionParticipants 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. |
| Conventional Cardiopulmonary Resuscitation | Active comparator | Procedure: Conventional Cardiopulmonary ResuscitationParticipants 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. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Age ≥18 years.
- Suspected out-of-hospital cardiac arrest (OHCA) as determined by the EMS dispatch center.
- Non-traumatic cause of cardiac arrest.
- The physician response unit is dispatched by the EMS dispatch center to the resuscitation scene.
Key exclusion criteria (14 listed)
- The patient is found not to have OHCA after arrival of the physician response unit.
- The patient has obvious signs of irreversible death upon arrival of the physician response unit, including decapitation, rigor mortis, livor mortis, decomposition, or other apparent signs of death.
- The family clearly expresses a wish not to attempt resuscitation, or the patient has a pre-existing Do Not Attempt Resuscitation order.
- The patient has contraindications to TEE, including:
- The scene condition may damage the device or endanger the rescue team, including but not limited to strong electromagnetic fields, such as high-voltage power facilities; extreme weather, such as heavy rain or snowstorm; hazardous environments, such as flooding, fire scenes, unstable buildings, major incident scenes, toxic chemical disasters, nuclear disasters, or any other scene judged unsafe by the on-scene EMS commander.
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 |
|---|---|---|
| Transesophageal Echocardiography-Guided Chest CompressionAlso: TEE-Guided CPRDuring 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. | Procedure or surgery | TEE-Guided Cardiopulmonary Resuscitation |
| Conventional Cardiopulmonary ResuscitationAlso: Conventional CPR, Standard CPRDuring 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. | Procedure or surgery | Conventional Cardiopulmonary Resuscitation |
Primary outcome
Any Return of Spontaneous Circulation
Time frame: up to 1 day
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.
8 secondary outcomes
Sustained Return of Spontaneous Circulation
Time frame: up to 1 day
Prehospital Return of Spontaneous Circulation
Time frame: up to 1 day
Survival With Spontaneous Circulation at Emergency Department Arrival
Time frame: up to 1 day
Survival to Intensive Care Unit Admission
Time frame: up to 1 month
Survival at 30 days
Time frame: 1 month
Survival to Hospital Discharge
Time frame: up to 1 year
Favorable Neurological Outcome at Hospital Discharge
Time frame: up to 1 year
Achieving EtCO₂ ≥20 mmHg During Prehospital CPR
Time frame: up to 1 day
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 2 Nov 2026.
- Background: PubMed 41122888Kleinman ME, Buick JE, Huber N, Idris AH, Levy M, Morgan SG, Nassal MMJ, Neth MR, Norii T, Nunnally ME, Rodriguez AJ, Walsh BK, Drennan IR. Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025 Oct 21;152(16_suppl_2):S448-S478. doi: 10.1161/CIR.0000000000001369. Epub 2025 Oct 22.
- Background: PubMed 41122884Wigginton JG, Agarwal S, Bartos JA, Coute RA, Drennan IR, Haamid A, Kudenchuk PJ, Link MS, Panchal AR, Pelter MM, Del Rios M, Rodriguez AJ, Perman SM, Sanko S, Kotini-Shah P, Kurz MC. Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025 Oct 21;152(16_suppl_2):S538-S577. doi: 10.1161/CIR.0000000000001376. Epub 2025 Oct 22.
- Background: PubMed 40561981Tseng BY, Yang CJ, Sun JT, Liu YT, Yadav K, Hsieh YL, Chu SE, Lee CW, Lee YK, Tsai TY. Trends in Studies on Transesophageal Echocardiography in Emergency Medicine: A Scoping Review. West J Emerg Med. 2025 May 14;26(3):469-477. doi: 10.5811/westjem.24870.
- Background: PubMed 30773413Fair J 3rd, Mallin MP, Adler A, Ockerse P, Steenblik J, Tonna J, Youngquist ST. Transesophageal Echocardiography During Cardiopulmonary Resuscitation Is Associated With Shorter Compression Pauses Compared With Transthoracic Echocardiography. Ann Emerg Med. 2019 Jun;73(6):610-616. doi: 10.1016/j.annemergmed.2019.01.018. Epub 2019 Feb 14.
- Background: PubMed 38086182Teran F, West FM, Jelic T, Taylor L, Jafry ZM, Burns KM, Owyang CG, Emt CC, Abella BS, Andrus P; On behalf ACEP Emergency Ultrasound Section and the Resuscitative TEE Collaborative Registry (rTEECoRe) Investigators. Resuscitative transesophageal echocardiography in emergency departments in the United States and Canada: A cross-sectional survey. Am J Emerg Med. 2024 Feb;76:164-172. doi: 10.1016/j.ajem.2023.11.041. Epub 2023 Nov 29.
- Background: PubMed 32762909Teran F, Prats MI, Nelson BP, Kessler R, Blaivas M, Peberdy MA, Shillcutt SK, Arntfield RT, Bahner D. Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week. J Am Coll Cardiol. 2020 Aug 11;76(6):745-754. doi: 10.1016/j.jacc.2020.05.074.
- Background: PubMed 40090608Kruit N, Ferguson I, Dieleman J, Burns B, Shearer N, Tian D, Dennis M. Use of transoesophageal echocardiography in the pre-hospital setting to determine compression position in out of hospital cardiac arrest. Resuscitation. 2025 Apr;209:110582. doi: 10.1016/j.resuscitation.2025.110582. Epub 2025 Mar 14.
- Background: PubMed 39387637Bianconi K, Hanna M, Visveswaran G, Patel R, Pompa J, Glucksman A, Cavaliere G, Steenberg M, Tagore A, Ariyaprakai N. Retrospective Review of the Image Quality of Monoplane Transesophageal Echocardiography in Prehospital Out-of-Hospital Cardiac Arrest: A Single Center Pilot Study. Prehosp Emerg Care. 2025;29(6):820-825. doi: 10.1080/10903127.2024.2411720. Epub 2024 Nov 1.
- Background: PubMed 37973909Krammel M, Hamp T, Hafner C, Magnet I, Poppe M, Marhofer P. Feasibility of resuscitative transesophageal echocardiography at out-of-hospital emergency scenes of cardiac arrest. Sci Rep. 2023 Nov 16;13(1):20085. doi: 10.1038/s41598-023-46684-x.
- Background: PubMed 30825552Catena E, Ottolina D, Fossali T, Rech R, Borghi B, Perotti A, Ballone E, Bergomi P, Corona A, Castelli A, Colombo R. Association between left ventricular outflow tract opening and successful resuscitation after cardiac arrest. Resuscitation. 2019 May;138:8-14. doi: 10.1016/j.resuscitation.2019.02.027. Epub 2019 Feb 27.
- Background: PubMed 38780398Chu SE, Huang CY, Cheng CY, Chan CH, Chen HA, Chang CH, Tsai KC, Chiu KM, Ma MH, Chiang WC, Sun JT. Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Prospective Observational Cohort Study. Crit Care Med. 2024 Sep 1;52(9):1367-1379. doi: 10.1097/CCM.0000000000006336. Epub 2024 May 23.
- Background: PubMed 41870444Chu SE, Cheng CY, Chang CJ, Ho H, Chen HA, Chan CH, Ma MH, Chang CH, Tsai KC, Chiu KM, Chen LW, Chiang WC, Sun JT. Transesophageal Echocardiography During CPR in Patients With Out-of-Hospital Cardiac Arrest: The EXECT-CPR Randomized Clinical Trial. JAMA Intern Med. 2026 May 1;186(5):557-566. doi: 10.1001/jamainternmed.2026.0102.
- Individual participant dataSharing planned: 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.
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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.
Sheng-En Chu, physician contact
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Transesophageal Echocardiography-Guided Chest Compression and Conventional Cardiopulmonary Resuscitation in people with Out-of-hospital Cardiac Arrest (OHCA), run by Far Eastern Memorial Hospital at 1 site in Taiwan.
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 5 inclusion and 14 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: opening soon, as of the sponsor's last update on 2 Nov 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 Taiwan. 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 Chiao-Yin Cheng, PhD. (+88677281125, chiaoyin810406@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Any Return of Spontaneous Circulation (time frame: up to 1 day). 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 NCT07909642, which also lists 12 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 2 Nov 2026.