A beep breaks the silence in the ambulance; the dispatch center sends details of a cardiovascular arrest. Every minute counts now – the two paramedics Mareike and Hakan make their way straight to the emergency. Minutes later they’re on scene with the patient. A 67-year-old man has collapsed at a family celebration – family members started CPR straightaway, following the instructions given by the dispatch center. Mareike and Hakan take over the patient care, their every action trained over and over, and put into practice: Chest compressions, application of the ECG electrodes and intubation.
A new feature for MEDUMAT Standard2
Mareike and Hakan have been relying for years on “their MEDUMAT” to ventilate patients. For the past few months they’ve been using a new feature of MEDUMAT Standard2: CCSV – a ventilation mode developed specifically for CPR. It couldn’t be easier to use for Mareike and Hakan as CCSV is optimally integrated into their CPR procedure. A pressure-controlled mechanical breath is triggered in sync with each chest compression, improving hemodynamics and gas exchange. Apart from ease of use, Hakan and Mareike were equally impressed by the initial experience reports on CCSV: 61.8 percent1 of patients achieved ROSC in the out-of-hospital setting; the average is 36.9 percent2. The longest ventilation period with CCSV was 40:24 minutes1. 93 percent3 of users also rated CCSV as helpful in an emergency. Mareike and Hakan managed to resuscitate their patient with help from CCSV. The pair take the patient with ROSC to the hospital for further treatment.
How exactly does CCSV work
WEINMANN Emergency developed the ventilation mode Chest Compression Synchronized Ventilation – CCSV for short – specifically for resuscitation. The mode is a software option for MEDUMAT Standard² that ensures a pressure-controlled mechanical breath is applied in sync with each chest compression. This innovative process demonstrably improves gas exchange and hemodynamics4. The essential effect of chest compressions is an increase in the intrathoracic pressure that causes the blood circulation to be maintained or restored. But at the same time, air does escape from the lungs, which inhibits the effect of the pressure buildup and thus reduces cardiac output (see Figure 1).
Ventilation with continuous chest compressions has proved challenging for decades, with few research studies devoted specifically to this issue. The negative effects of conventional ventilation procedures are well-known: Asynchronous ventilation can cause unpredictable changes in breath volumes and airway pressures. In addition, ventilation during chest wall recoil can impair venous return and cardiac output.
This is precisely where CCSV comes into play. No gas volume can escape through the mechanical breath administered in sync with the chest compression: The pressure in the lungs – and, in turn, the arterial pressure – rises (see Figure 2), venous return is not impeded and cardiac output increases. The synchronous pressure-controlled ventilation also eliminates unpredictable pressure peaks.
The increased use of mechanical chest compression devices presents another challenge for ventilation during resuscitation. Optimal integration of CCSV into the resuscitation process ensures the ventilation mode is compatible with standard chest compression devices.
CCSV offers not just medical benefits
Apart from the medical benefits, CCSV can also provide assistance during the reanimation process. As ventilation only takes place when chest compressions are performed, ventilation is automatically interrupted during the analysis phase. When restarting compressions, the ventilation kicks in automatically. The compression frequency and the hands-off time can also be checked in CCSV mode.
The CCSV video provides an overview with all the facts
Bibliography:
- 1) Kill C, et al: Mechanical positive pressure ventilation during resuscitation in out-of-hospital cardiac arrest with chest compression synchronized ventilation (CCSV) In: Resuscitation 142, e42, doi.org/10.1016/j.resuscitation.2019.06.102
- 2) Wnent J, et al: Außerklinische Reanimation 2018 des Deutschen Reanimationsregisters [Out-of-Hospital Resuscitation 2018 of the German Resuscitation Registry (GRR)] In: Anästh Intensivmed, 2019;60:1-3, https://www.reanimationsregister.de/downloads/oeffentliche-jahresberichte/rettungsdienst/142-2019-ausserklinischer-jahresbericht-2018/file.html
- 3) WEINMANN Emergency GmbH+Co. KG: Results of a survey as part of the post-market clinical follow-up of CCSV, 10/2019.
- 4) Kill C, et al. Mechanical ventilation during cardiopulmonary resuscitation with intermittent positive-pressure ventilation, bilevel ventilation, or chest compression synchronized ventilation in a pig model. Crit Care Med. 2014 Feb;42(2):e89-95.
Kill C, et al. Chest compression synchronized ventilation versus intermitted positive pressure ventilation during cardiopulmonary resuscitation in a pig model. PLoS One. 2015 May 26;10(5):e0127759