Cardiac arrest (CA) is a leading cause of death in the U.S. Interventions remain largely ineffective with low overall survival rates and frequent organ dysfunction among survivors. We plan to leverage individual Co-PI expertise to generate an interdisciplinary clinician-scientist team with the overarching aim of comprehensively studying pre-clinical models of CA that ultimately lead to improved outcomes. The present proposal will serve as a first step to ignite a long-lasting collaboration to strategically position our team to compete for a multi-PI R01 application. Specifically, our proposal builds upon our prior clinical work using transesophageal echocardiography (TEE) demonstrating that chest compression (CC) is often suboptimal under guidelinedirected standards. When CA resuscitation is performed under current guidelines, obstruction of the left ventricular outflow tract (LVOT) is common. Our approach uses TEE to tailor location of CC to each individual's anatomy, maximizing forward blood flow during CC. We hypothesize that compression of the LVOT not only decreases forward blood flow and survival outcomes, but that it may also adversely affect right ventricular (RV) function, contributing to the development of RV dysfunction and acute lung injury in CA survivors. In preparation for an R01 proposal, this grant aims to establish and refine a survival model of ventricular fibrillation CA in pigs with the goal to determine the impact of CC location on return of spontaneous circulation (ROSC), LV and RV hemodynamics, RV and lung injury, frequency and magnitude of CPR-related injuries, and short-term survival.