Chest Compression Synchronized Mechanical Ventilation Modes for Cardiac Arrest; A Scoping Review
Archives of Academic Emergency Medicine,
Vol. 13 No. 1 (2025),
6 September 2025
,
Page e73
https://doi.org/10.22037/aaem.v13i1.2782
Abstract
Introduction: Chest Compression Synchronized Ventilation (CCSV) is a novel approach aimed at optimizing gas exchange and hemodynamics during cardiopulmonary resuscitation (CPR). However, its clinical value, safety profile and implementation barriers remain unclear. This study aimed to systematically synthesize existing evidence on the use of CCSV during cardiac arrest in animals and humans.
Methods: We conducted a scoping review and systematically searched five databases (Medline, Embase, CENTRAL, Scopus, Web of Science) up to May 2025. Studies investigating CCSV or mechanistically related ventilation strategies during cardiac arrest were included regardless of study design, language or publication date. Data were charted for study characteristics, outcomes and adverse events.
Results: Thirty-two studies published between 1980 and 2025 were included. Most were animal studies (n=19), primarily conducted in pigs, with limited human data (n=10). CCSV showed positive effects on arterial oxygenation, carbon dioxide clearance, and hemodynamic parameters as well as cerebral oxygenation compared to conventional ventilation modes. Adverse events such as pneumothorax and lung injury were inconsistently reported.
Conclusions: Available data on CCSV suggests potential physiological benefits during CPR, particularly in experimental settings. Human data remain scarce, and larger, prospective human trials are essential to evaluate clinical effectiveness, guide implementation, and assess risks compared to conventional ventilation strategies.
- CPR
- controlled ventilation
- Cardiac Arrest
- Cardiopulmonary resuscitation
- Ventilation
- Chest compression
- review
How to Cite
References
Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021 Apr;161:115–51.
Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S366–468.
Krischer JP, Fine EG, Weisfeldt ML, Guerci AD, Nagel E, Chandra N. Comparison of prehospital conventional and simultaneous compression-ventilation cardiopulmonary resuscitation. Crit Care Med. 1989;17(12):1263.
Orso D, Vetrugno L, Federici N, Borselli M, Spadaro S, Cammarota G, et al. Mechanical Ventilation Management During Mechanical Chest Compressions. Respir Care. 2021 Feb 1;66(2):334–46.
Cordioli RL, Brochard L, Suppan L, Lyazidi A, Templier F, Khoury A, et al. How Ventilation Is Delivered During Cardiopulmonary Resuscitation: An International Survey. Respir Care. 2018 Oct;63(10):1293–301.
Chandra N, Rudikoff M, Weisfeldt MyronL. SIMULTANEOUS CHEST COMPRESSION AND VENTILATION AT HIGH AIRWAY PRESSURE DURING CARDIOPULMONARY RESUSCITATION. Orig Publ Vol 1 Issue 8161. 1980;315(8161):175–8.
Azcarate I, Urigüen JA, Leturiondo M, Sandoval CL, Redondo K, Gutiérrez JJ, et al. The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation. J Clin Med. 2023 Nov 3;12(21):6918.
Orlob S, Wittig J, Hobisch C, Auinger D, Honnef G, Fellinger T, et al. Reliability of mechanical ventilation during continuous chest compressions: a crossover study of transport ventilators in a human cadaver model of CPR. Scand J Trauma Resusc Emerg Med. 2021 July 28;29(1):102.
Senthilnathan M, Ravi R, Suganya S, Kumar Sivakumar R. Manual vs. mechanical ventilation in patients with advanced airway during CPR. Indian Heart J. 2022;74(5):428–9.
Neth MR, Idris A, McMullan J, Benoit JL, Daya MR. A review of ventilation in adult out‐of‐hospital cardiac arrest. J Am Coll Emerg Physicians Open. 2020 June;1(3):190–201.
Oh YT, Lee CA, Park HA, Park J, Kim S, Park HJ, et al. Effectiveness of Chest Compression-Synchronized Ventilation in Patients with Cardiac Arrest. J Clin Med. 2025 Mar 31;14(7):2394.
IPPV-Beatmung [Internet]. [cited 2025 Mar 23]. Available from: https://www.weinmann-emergency.com/de/themen/notfallbeatmung/ippv
Hillman DR. Physiological aspects of intermittent positive pressure ventilation. Anaesth Intensive Care. 1986 Aug;14(3):226–35.
Seymour CW, Frazer M, Reilly PM, Fuchs BD. Airway Pressure Release and Biphasic Intermittent Positive Airway Pressure Ventilation: Are They Ready for Prime Time?: J Trauma Inj Infect Crit Care. 2007 May;62(5):1298–309.
Weinmann Emergency. CCSV Whitepaper [Internet]. [cited 2024 Nov 11]. Available from: https://weinmann-emergency.canto.de/pdfviewer/viewer/viewer.html?v=downloadEN&portalType=v%2FdownloadEN&column=document&id=mv8v00td1158dd6let95dak53n&suffix=pdf&print=1
Peters MD, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis [Internet]. JBI; 2024 [cited 2025 June 23]. Available from: https://jbi-global-wiki.refined.site/space/MANUAL/355862497/10.+Scoping+reviews
Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020 Oct;18(10):2119–26.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2;169(7):467–73.
Cao G, Gao G, Xu J, Wang X, Ge F, Zhu J, et al. The study on the effect of automatic compression synchronous ventilation mode on cardiopulmonary resuscitation in pigs. Chin J Emerg Med. 2024;33(9):1257–64.
Intra-Arrest-Ventilation in Human Cadavers. Intra-Arrest-Vent - Prospect Randomized Trial Hum Cadavers [Internet]. 2024; Available from: https://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=cctr&AN=CN-02681503
Evaluation of the effectiveness of Chest Compression Synchronized Ventilation in cardiac arrest patients. 2023; Available from: https://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=cctr&AN=CN-02587989
Chandra N, Weisfeldt ML, Tsitlik J. Augmentation of carotid flow during cardiopulmonary resuscitation by ventilation at high airway pressure simultaneous with chest compression. Am J Cardiol. 1981;48(6):1053–63.
Hou SH, Lue HC, Chu SH. Comparison of conventional and simultaneous compression-ventilation cardiopulmonary resuscitation in piglets. Jpn Circ J. 1994;58(6):426–32.
Chandra N, Guerci A, Weisfeldt ML, Tsitlik J, Lepor N. Contrasts between intrathoracic pressures during external chest compression and cardiac massage. Crit Care Med. 1981 Nov;9(11):789–92.
Malinverni S, Sarnelli M, De Longueville D, Bartiaux M, Group BCAR. Out of hospital cardiac arrest ventilation using Cardiopulmonary VentilationTM is associated with increased incidence of return of spontaneous circulation. Crit Care [Internet]. 2023;27. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L641087665&from=export
Schaller SJ, Altmann S, Unsworth A, Schneider G, Bogner-Flatz V, Paul T, et al. Continuous chest compressions with a simultaneous triggered ventilator in the Munich Emergency Medical Services: a case series. Ger Med Sci GMS E-J. 2019;17:Doc06.
Olasveengen TM, Skare C, Skjerven-Martinsen M, Hoff-Olsen P, Kramer-Johansen J, Hoff Nordum F, et al. Lung tissue injury and hemodynamic effects of ventilations synchronized or unsynchronized to continuous chest compressions in a porcine cardiac arrest model. Resusc Plus. 2024;17(101774410):100530.
Renz M, Müller L, Herbst M, Riedel J, Mohnke K, Ziebart A, et al. Analysis of cerebral Interleukin-6 and tumor necrosis factor alpha patterns following different ventilation strategies during cardiac arrest in pigs. PeerJ [Internet]. 2023;11. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L2027755692&from=export
Kopra J, Mehtonen L, Laitinen M, Litonius E, Oestman R, Heinonen J, et al. Chest compression synchronized ventilation is associated with improved oxygenation but also with increased incidence of pneumothoraces in an experimental CPR model. CIRCULATION. 2024;150.
Manegold R, Scheene P, Al-Rashid F, Kill C, Riße J. Influence of aortal occlusion during non-trauma resuscitation on gas exchange in a pig model with chest compression synchronized ventilation. Resuscitation. 2023;192:S111.
Hu H, Xu J, Zhang M, Wang J. EFFICACY OF CHEST COMPRESSION SYNCHRONIZED VENTILATION ON BRAIN TISSUE OXYGENATION IN A PORCINE CARDIOPULMONARY RESUSCITATION MODEL. 2022;31(10).
Kill C, Hahn O, Dietz F, Neuhaus C, Schwarz S, Mahling R, 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;42(2):e89-95.
Renz M, Noack R, Rissel R, Mohnke K, Riedel J, Dunges B, et al. Synchronized ventilation during resuscitation in pigs does not necessitate high inspiratory pressures to provide adequate oxygenation. WORLD J Emerg Med. 2023;14(5):393–6.
Xu J, Khan ZU, Zhang M, Wang J, Zhou M, Zheng Z, et al. The combination of chest compression synchronized ventilation and aortic balloon occlusion improve the outcomes of cardiopulmonary resuscitation in swine. Front Med [Internet]. 2022;9. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L2020938249&from=export
Kill C, Thonke R, Hahn O, Wallot P, Kesper K, Wulf H, 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. Resuscitation. 2015;96:44.
Kill C, Dersch W, Hahn O, Neuhaus C, Dietz F, Mahling R, et al. Chest compression synchronized ventilation during CPR: Influence of a novel ventilator mode on gas exchange in a pig model. Resuscitation. 2011;82:S15.
Kill C, Wallot P, Hahn O, Neuhaus C, Dietz F, Schwarz S, et al. Chest compression synchronized ventilation during cpr: Influence on haemodynamics in a pig model. Resuscitation. 2011;82:S15.
Dietz F, Neuhaus C, Dersch W, Wallot P, Hahn O, Schwarz S, et al. Chest compression synchronized ventilation during CPR: Technical solution and flow-volume curves of a novel ventilator mode. Resuscitation. 2011;82:S13.
Kill C, Galbas M, Neuhaus C, Hahn O, Wallot P, Kesper K, et al. Chest Compression Synchronized Ventilation versus Intermitted Positive Pressure Ventilation during Cardiopulmonary Resuscitation in a Pig Model. PloS One. 2015;10(5):e0127759.
Dersch W, Wallot P, Hahn O, Sauerbrei C, Jerrentrup A, Neuhaus C, 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 modelCategory: CPR Systems. Resuscitation. 2012;83:e3.
Dersch W, Hoselmann P, Neuhaus C, Palm U, Bösl E, Wallot P, et al. Resuscitation with mechanical ventilation: The effects of Chest Compression Synchronized Ventilation (CCSV) or Intermitted Positive Pressure Ventilation (IPPV) on lung injury in a pig model. Resuscitation. 2013;84:S15.
van der Velde J, Dolan P, Fogarty E. Fully Automated Cardiopulmonary Resuscitation - a Bridge to ECMO. Resuscitation. 2023;192:S52–3.
Kill C, Paul C, Manegold RK, Holzner C, Blomeyer R, Risse J. Mechanical positive pressure ventilation during resuscitation in out-of-hospital cardiac arrest with chest compression synchronized ventilation (CCSV). Resuscitation. 2019;142:e42.
Hernández-Tejedor A, Puebla VG, Torres EC, Montero Hernández SI, Rodrigo CC, Vázquez García MI, et al. Comparison of ventilation modes in non-traumatic out-of-hospital cardiac arrest: SYMEVECA phase 2. Resuscitation. 2025 May;110655.
Speer T, Dersch W, Kleine B, Neuhaus C, Kill C. Mechanical Ventilation During Resuscitation: how Manual Chest Compressions Affect a Ventilator’s Function. Adv Ther. 2017;34(10):2333.
Segal N. Intermittent positive-pressure ventilation, chest compression synchronized ventilation, bilevel ventilation, continuous chest compression, active compression decompression, and impedance threshold device - The complexity of ventilation during cardiopulmonary resuscitation. Crit Care Med. 2014;42(2):480–1.
World Bank Data Help Desk. World Bank Country and Lending Groups [Internet]. [cited 2025 Apr 14]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
Chandra N, Rudikoff M, Weisfeldt MyronL. SIMULTANEOUS CHEST COMPRESSION AND VENTILATION AT HIGH AIRWAY PRESSURE DURING CARDIOPULMONARY RESUSCITATION. The Lancet. 1980 Jan;315(8161):175–8.
Kill C, Manegold RK, Fistera D, Risse J. Airway management and ventilation techniques in resuscitation during advanced life support: an update. J Anesth Analg Crit Care. 2024;4(1):58.
Dietz F, Neuhaus C, Dersch W, Wallot P, Hahn O, Schwarz S, et al. Chest compression synchronized ventilation during CPR: Technical solution and flow-volume curves of a novel ventilator mode. Resuscitation. 2011;82((Dietz F.) Weinmann Geräte für Medizin GmbH+Co.KG, Hamburg, Germany):S13.
Segal N. Intermittent positive-pressure ventilation, chest compression synchronized ventilation, bilevel ventilation, continuous chest compression, active compression decompression, and impedance threshold device - The complexity of ventilation during cardiopulmonary resuscitation. Crit Care Med. 2014;42(2):480–1.
Intra-Arrest-Ventilation in Human Cadavers. Intra-Arrest-Vent - Prospect Randomized Trial Hum Cadavers [Internet]. 2024 [cited 2024 Jan 1]; Available from: https://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=cctr&AN=CN-02681503
Haywood K, Whitehead L, Nadkarni VM, Achana F, Beesems S, Böttiger BW, et al. COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Resuscitation. 2018 June;127:147–63.
Segond N, Wittig J, Kern WJ, Orlob S. Towards a common terminology of ventilation during cardiopulmonary resuscitation. Resuscitation. 2025 Feb;207:110511.
- Abstract Viewed: 591 times
- pdf Downloaded: 658 times
Download Statastics
Make a Submission
SJR
COPE
