{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T11:39:33Z","timestamp":1792496373508,"version":"4.5.0"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"\n Importance<\/jats:title>\n Cardiopulmonary resuscitation (CPR) guidelines recommend chest compressions at the lower half of the sternum. This may lead to aortic valve compression, which is associated with poor outcomes, while compressions over the left ventricle are seldom achieved.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To test the hypothesis that transesophageal echocardiography (TEE) guidance during CPR to avoid aortic valve compression and target the left ventricle would improve outcomes in patients with nontraumatic out-of-hospital cardiac arrest compared with conventional CPR.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cluster-randomized clinical trial (the EXECT-CPR study) was conducted from June 26 to November 19, 2023, at 1 tertiary medical center in Taiwan. Participants were adults who consecutively presented to the emergency department (ED) with nontraumatic out-of-hospital cardiac arrest. Exclusion criteria were prehospital return of spontaneous circulation, extracorporeal CPR, contraindications to TEE, prior do-not-resuscitate orders, and obvious signs of death. Complete blinding was not feasible; the allocation schedule was disclosed only to the principal investigator.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Post\u2013ED arrival CPR at TEE-guided (avoid aortic-valve compression and target the left ventricle) or guideline-recommended (the lower half of the sternum) site.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was a sustained return of spontaneous circulation (\u226520 minutes). Secondary outcomes were any return of spontaneous circulation, survival to intensive care unit admission, survival to hospital discharge, cerebral performance category of 2 or lower at discharge, and intra-CPR end-tidal carbon dioxide levels.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 132 patients underwent randomization (66 in each group; median [IQR] age, 68 [55-74] years; 87 [66%] male). The primary outcome was similar between groups (TEE-guided group, 29 [44%]; conventional group, 26 [39%]; cluster-adjusted odds ratio, 1.21; 95% CI, 0.64-2.29). The secondary outcomes also did not significantly differ, except for higher intra-CPR end-tidal carbon dioxide levels in the TEE-guided group during the 11th to 20th minutes after arrival. Adverse event rates related to TEE and CPR were comparable.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial among adults transported to the emergency department with ongoing CPR for nontraumatic out-of-hospital cardiac arrest, TEE-guided CPR with an adjusted compression site after arrival did not significantly improve clinical outcomes compared with conventional CPR, although it produced potential hemodynamic benefits without increasing adverse events. Given that the trial was underpowered due to optimistic effect size assumptions, these neutral findings should be interpreted with caution.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05907460<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamainternmed.2026.0102","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T15:30:28Z","timestamp":1774279828000},"page":"557","source":"Crossref","is-referenced-by-count":7,"title":["Transesophageal Echocardiography During CPR in Patients With Out-of-Hospital Cardiac Arrest"],"prefix":"10.1001","volume":"186","author":[{"given":"Sheng-En","family":"Chu","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan"},{"name":"Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan"},{"name":"Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan"},{"name":"Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiao-Yin","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan"},{"name":"Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Jung","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsuan-An","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Hsiang","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Geography, National Taiwan Normal University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew H.","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan"},{"name":"Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin-Ho","family":"Chang","sequence":"additional","affiliation":[{"name":"National Taiwan University Hospital Statistical Consulting Unit, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuang-Chau","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan-Ming","family":"Chiu","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan"},{"name":"Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee-Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Chu","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan"},{"name":"Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jen-Tang","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"16_suppl_2","key":"ioi260006r1","doi-asserted-by":"publisher","first-page":"S366","DOI":"10.1161\/CIR.0000000000000916","article-title":"Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular 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Use of transesophageal echocardiography (TEE) in the ED for shock, cardiac arrest, and procedural guidance. June 2023. 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