Assessing TEE-Guided CPR in Improving Clinical Outcomes in Adults With OHCA

Background: Out-of-hospital cardiac arrest (OHCA) is common and usually associated with a poor prognosis. The American Heart Association recommends high-quality cardiopulmonary resuscitation (CPR) as the most important intervention in OHCA and recommends chest compressions at the center of the chest and lower portion of the sternum at a rate of 100 to 120/minute and a depth of ≥2 inches. Unfortunately, studies with transesophageal echocardiography (TEE) have suggested that this positioning results in compression of the aortic valve and/or aortic root around 50% of the time with concerns that this malpositioning may cause coronary and/or cerebral ischemia. Animal research has suggested better CPR outcomes with more proper compression location over the left ventricle, and a human study suggested better chances of return of spontaneous circulation (ROSC) and ICU admission but no suggestion of better ultimate outcomes. Objective: To determine if TEE-guided repositioning of resuscitation more...