CCSV - Ventilation Mode for Resuscitation

A rescuer gives CPR

Revolutionary technique from WEINMANN Emergency

For decades, ventilation with continuous chest compressions has presented a challenge in CPR. This is because in addition to the need to maintain both the circulation of blood and perfusion, blood requires the best possible oxygenation.

This is hard to implement, especially with significantly reduced cardiac output. The largely non-standard techniques which have been in use up to now have a risk of less than optimal ventilation because of complex settings and thus the possibility of operating errors.

This is where CCSV comes in: Simple to operate and perfectly integrated in the resuscitation sequence, MEDUMAT Standard² in CCSV mode ensures optimal oxygenation and decarboxylation of blood during CPR!

A "real" ventilation mode for use during CPR was hardly available before.

Markus ReichenbachLead paramedic of Rega and base leader in Mollis (GL)

How CCSV works

In conventional ventilation, the heart and the pulmonary vessels in the thorax are compressed during chest compressions, but the rise in intrathoracic pressure causes air to escape from the lungs, inhibiting the effect of pressure buildup and thus reducing cardiac output.

In ventilation during CPR under CCSV, a pressure-controlled mechanical breath is executed to synchronize with the chest compression performed, preventing any volume of gas escaping from the thorax; the increased pressure in the lungs ensures more vigorous compression of the heart during chest compressions. Cardiac output rises, ensuring improved gas exchange.

In the decompression phase, the device automatically switches to expiration to force air out of the lungs. At the same time, intrathoracic pressure drops and venous return to the heart proceeds unhindered.

Conventional ventilation

Conventional ventilation

Ventilation during CPR under CCSV

Functionality of ventilation under CCSV

A summary of the benefits

Arterial and venous blood pressure with CCSV
Figure 1: Arterial (red line) and central venous (gray line) blood pressure under CCSV ventilation. Source: WEINMANN Emergency, 04/2020, [2, p.3]

Improved hemodynamics and oxygenation

Increasing intrathoracic pressure increases arterial blood pressure and the difference between arterial and central venous blood pressure (see Figure 1). This is crucial for cardiac and cerebral perfusion pressure.

A study[1] looked into CPR under CCSV compared to IPPV and BiLevel (BiPAP) in terms of gas exchange and hemodynamics. It demonstrated that CPR in CCSV mode leads to improved oxygenation, a normal venous pH and a significantly higher arterial blood pressure. CCSV thus makes a positive contribution to hemodynamics.

Arterial carbon dioxide partial pressure PaCO2 compared at IPPV and CCSV
Figure 2: Comparison of arterial partial pressure of carbon dioxide PaCO2 under IPPV and CCSV. Source: WEINMANN Emergency, 04/2020, [2, p.5]

Adequate alveolar ventilation

In addition to maintaining perfusion and oxygenation, the elimination of CO2 plays a key role in CPR. To prevent respiratory acidosis, it is important to maintain the partial pressure of carbon dioxide at as normal a value as possible.

The effect of CCSV on the arterial partial pressure of carbon dioxide during CPR was examined in a further study[3]. Continuous administration of low tidal volumes above dead space volume under CCSV ensures that neither hypoventilation nor hyperventilation occur. As can be seen in Figure 2, it is possible to achieve normocapnia during CPR with CCSV, allowing us to draw the conclusion that CCSV can prevent hypercapnia and thus prevent respiratory acidosis.

Cerebral oxygenation compared in IPPV and CCSV
Figure 3: Comparison of cerebral oxygenation under IPPV and CCSV. Source: WEINMANN Emergency, 04/2020, [2, p.5]

Improved cerebral oxygenation

Another interesting aspect is the effect of CCSV on cerebral oxygenation during CPR. A study[4] continuously measured the oxygen saturation of cerebral tissue (ScO2) during CPR (see Figure 3). This showed that under CCSV ventilation, it was possible to stop ScO2 dropping to below the initial value, even without administering adrenaline (t = 6 min). This suggests that CCSV improves cerebral oxygenation compared to IPPV.

Samples of lung tissue were also examined for morphological indications of ventilator-associated lung injury (VALI). In terms of potential damage to lung tissue,
there were no differences between IPPV and CCSV.

Rescuer resuscitates a patient by using the MEDUMAT Standard²

Uninterrupted chest compressions

During CPR, chest compressions are interrupted in favor of manual ventilation. This leads to a drop in cardiac blood flow and has a potentially negative impact on the efficacy of resuscitation – a drawback which could affect your patients’ survival! This is why the ILCOR guidelines recommend performing uninterrupted chest compressions on patients as quickly as possible.

Once the airway has been secured, CCSV provides a remedy for this. MEDUMAT Standard² detects every chest compression automatically. If ventilation during CPR is performed in CCSV mode, the device triggers a mechanical breath to synchronize with every chest compression. Users can perform chest compressions without interruption. A frequency tachometer helps users maintain the optimum compression frequency.

Easily integrated in the resuscitation technique

At the emergency site, users commence CPR using the 30:2 technique as usual. Once the patient’s airway is secured by an endotracheal tube, you can switch to CCSV mode. Whilst users perform uninterrupted chest compressions, MEDUMAT Standard² in CCSV mode ensures adequate ventilation at every point.

Scientific information about CCSV

CCSV is the result of our many years’ experience in the field of emergency and transport ventilation and our participation in various scientific research projects. We have drafted a white paper which summarizes information about CCSV from scientific publications. Delve deeper into this topic to learn more about the benefits of CCSV.

Download here

Do you still have questions about how it works?

Every innovation raises questions, we realize that, which is why we have put together some FAQs for you to cover common questions about the medical background and application of CCSV in practice.

Got to FAQs

All the important parameters at a glance

CCSV on MEDUMAT Standard<sup>2</sup>

Tidal volume

Tidal volume - volume delivered per mechanical breath

Hands-off time

time since last chest compression detected

etCO₂

If applicable, representation of the etCO₂

Trigger

sensitivity setting for compression detection

Type of compression

switch between manual and mechanical CPR at the touch of a button

PEEP

setting for positive end-expiratory pressure in the lungs. A higher PEEP may lead to better compression detection (can be set from 0 to 5 mbar)

Flow curve

displays the patient’s inspiration and expiration. “L” marks compressions detected and thus the trigger for ventilation

Frequency tachometer

shows current compression rate per minute

Training staff in the use of CCSV

Training video

Take a look at the numerous videos and animations about our products on our YouTube channel.

Open in Youtube

Simulation software

Use our interactive simulation software to familiarize yourself even more with the operation of MEDUMAT Standard² in CCSV mode and to try it out directly on your PC.

Download Software

On-site training

Would you like to train several people in CCSV simultaneously? We would be delighted to come and hold a training session on your premises.

Trainings Overview

Sources

[1] 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.

[2] WEINMANN Emergency Medical Technology GmbH + Co. KG: White Paper Chest Compression Synchronized Ventilation, 04/2020.

[3] Dersch W et al. Resuscitation and mechanical ventilation with Chest Compression Synchronized Ventilation (CCSV) or Intermitted Positive Pressure Ventilation (IPPV). Influence on gas exchange and return of spontaneous circulation in a pig model. https://doi.org/10.1016/j.resuscitation.2012.08.010

[4] Kill C, et al. Cerebral oxygenation during resuscitation: Influence of the ventilation modes Chest Compression Synchronized Ventilation (CCSV) or Intermitted Positive Pressure Ventilation (IPPV) and of vasopressors on cerebral tissue oxygen saturation. https://doi.org/10.1016/j.resuscitation.2015.09.101

[5] van der Velde J, et al. Fully Automated Cardiopulmonary Resuscitation - a Bridge to ECMO. In: Resuscitation 192, SUPPLEMENT 1, S52-S53, Nov 2023. https://doi.org/10.1016/S0300-9572(23)00467-7

[6] WEINMANN Emergency Medical Technology GmbH + Co. KG: Ergebnisse einer Befragung im Rahmen der klinischen Nachbeobachtung von CCSV, 10/2019.

[7] WEINMANN Emergency Medical Technology GmbH + Co. KG: Auswertung der internen Kundendatenbank, 11/2023.