Transesophageal Echocardiography Use During CPR Linked to Changes in Chest Compression Areas, Based on Healthcare Provider Experience

Rory A. Marshall, Kate DeVito-Porter, Geneviève Dallaire, Tom Jelic, Amanda Smith, Frank Myslik, Rohit Mohindra, Rajiv Thavanathan, Tracy D. Wilson, Paul Olszynski

Abstract

Ultrasound-guided cardiopulmonary resuscitation (UG-CPR) offers healthcare providers real-time, sonographic guidance during CPR. Transesophageal echocardiography-guided CPR (TEE-CPR) is limited to institutions with the prerequisite equipment and expertise.

Introduction

Despite an emphasis on high quality cardiopulmonary resuscitation (CPR) [1,2], and improved availability of automated defibrillators [3], survival rates for out-of-hospital cardiac arrests (OHCA) remain low [4]. Despite the heterogeneity of OHCA patients [5], uniformly performed chest compressions and basic common interventions remain a cornerstone of CPR [6].

Materials and methods

This Canadian multi-site study was reviewed and approved by the Research Ethics Board at the University of Saskatchewan (Beh 4008). Survey participants provided informed consent. Upon accessing the online survey, information about the study was provided and they were then given the option to participate by proceeding with the survey.

Results

N = 30 respondents from five Canadian sites described participating in UG-CPR resuscitations, 29 of whom had performed chest compressions during UG-CPR. Eighteen of the respondents described being involved in more than one TEE-CPR event, ranging from 2 to as many as 25 distinct TEE-CPR events.

Discussion

This survey of healthcare providers who have participated in TEE-CPR resuscitations revealed novel information on the differences in performing chest compressions during conventional and TEE-CPR. Nearly all providers reported witnessing TEE-CPR being used to alter the AOC to areas other than the conventional landmark (the lower half of the sternum).

Conclusion

Healthcare providers, with guidance from TEE, are performing chest compressions at alternative areas to the conventional AOC. The general nature of those adjustments is reported to be leftward and caudal, aligning with recent research that indicates chest compressions over the left ventricle increase CPR efficacy.

Citation: Marshall RA, DeVito-Porter K, Dallaire G, Jelic T, Smith A, Myslik F, et al. (2026) Transesophageal echocardiography during cardiopulmonary resuscitation is associated with alternate areas of compression: Analysis of healthcare provider experiences with potential implications for conventional compressions. PLoS One 21(1): e0339974. https://doi.org/10.1371/journal.pone.0339974

Editor: Sebastian Schnaubelt, Medical University of Vienna, AUSTRIA

Received: June 12, 2025; Accepted: December 15, 2025; Published: January 20, 2026

Copyright: © 2026 Marshall et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting information files.

Funding: This study was funded in part through the University of Saskatchewan’s Dean’s Summer Research Projects program, awarded to the student researcher (KD-P) as salary ($5000). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.