CCSV - Ventilation Mode for Resuscitation

Revolutionary technique from WEINMANN

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 and CO₂ elimination.

This is hard to implement, especially with significantly reduced cardiac output. With the current, poorly standardized procedures, there is still a risk of suboptimal ventilation.

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!

In addition, CCSV supports perfusion by specifically increasing intrathoracic pressure during compression.

How CCSV works

During chest compressions, the lungs are compressed as well as the heart. However, this reduction in intrathoracic pressure causes air to escape from the lungs, inhibiting the effect of blood pressure buildup and thus reducing cardiac output.

In ventilation during CPR with CCSV, a pressure-controlled mechanical breath is executed in synchrony with the chest compression, preventing any volume of gas escaping from the thorax; the increased pressure in the lungs ensures more vigorous compression of the heart. Arterial blood pressure increases and oxygenation and ventilation are improved compared to conventional methods such as IPPV. ^1.2

In the decompression phase, the device automatically switches to expiration to force air out of the lungs. Intrathoracic pressure decreases and venous return to the heart can occur unhindered.

A summary of the benefits

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.

An initial animal study conducted in 2014 showed that resuscitation in CCSV mode leads to improved oxygenation, normal venous pH, and significantly higher arterial blood pressure compared to IPPV and BiLevel (BIPAP).¹ The oxygenation results were also validated with initial human data, as shown in a recent randomized study from Seoul, South Korea. A direct comparison between IPPV and CCSV was performed, which demonstrated significantly improved oxygenation of arterial blood under CCSV.²

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 arterial carbon dioxide partial pressure (PaCO2) during resuscitation shows that even after 10 minutes of resuscitation with CCSV, there is a significant difference from the initial value.² Through the continuous, synchronized administration of low tidal volumes above the dead space volume, CCSV ventilation can maintain adequate ventilation and perfusion even during prolonged resuscitation.⁴

Improved cerebral oxygenation

The influence of CCSV on cerebral oxygenation during resuscitation is another important aspect. Investigations of cerebral tissue oxygen saturation (ScO₂) show that the use of CCSV can prevent ScO₂ from falling below baseline levels even without the administration of adrenaline (t = 6 min) (see Figure 3), indicating improved cerebral oxygenation compared to IPPV.⁸ These results were confirmed by another study from 2022, which demonstrated comparable effects under CCSV.⁷

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. This is why the ILCOR guidelines recommend performing uninterrupted chest compressions 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 quickly and easily switch to CCSV mode. Here, MEDUMAT Standard² ensures sufficient ventilation at all times in CCSV mode.

All the important parameters at a glance

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 Oh YT, et al. Effectiveness of Chest Compression-Synchronized Ventilation in Patients with Cardiac Arrest. J Clin Med. 2025 Mar 31;14(7):2394. doi: 10.3390/jcm14072394. PMID: 40217844; PMCID: PMC11989354.

³Hernández-Tejedor, Alberto et al. Comparison of ventilation modes in non-traumatic out-of-hospital cardiac arrest: SYMEVECA phase 2 Resuscitation, Volume 213, 110655

⁴ van der Velde J, et al. Fully Automated Cardiopulmonary Resuscitation - a Bridge to ECMO. In: Resuscitation 192, SUPPLEMENT 1, p. 52-53, Nov 2023. https://doi.org/10.1016/S0300-9572(23)00467-7

⁵ WEINMANN Emergency Medical Technology GmbH + Co. KG: Ergebnisse einer Befragung im Rahmen der klinischen Nachbeobachtung von CCSV (Results of a survey conducted during post-market clinical follow-up for CCSV), 10/2019.

⁶ WEINMANN Emergency Medical Technology GmbH + Co. KG: Evaluation of the internal customer database, 11/2023.

⁷Hu et al. Chest compression synchronized ventilation in a porcine CPR model. Effect on brain tissue oxygenation. Chin J Emerg Med, October 2022, Vol. 31, No. 10

⁸ 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

⁹ 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, https://doi.org/10.1016/j.resuscitation.2019.06.102