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. 2025 Mar 31;14(7):2394.
doi: 10.3390/jcm14072394.

Effectiveness of Chest Compression-Synchronized Ventilation in Patients with Cardiac Arrest

Young T Oh  1   2 , Choung A Lee  3 , Hang A Park  3 , Juok Park  3 , Sola Kim  3 , Hye J Park  3 , Sangsoo Han  4 , Soonjoo Wang  3 , Jong W Kim  5
Affiliations

Effectiveness of Chest Compression-Synchronized Ventilation in Patients with Cardiac Arrest

Young T Oh et al. J Clin Med. .

Abstract

Background/Objectives: The aim of this study was to determine the optimal ventilation mode during cardiopulmonary resuscitation (CPR) by comparing the effects of chest compression-synchronized ventilation (CCSV) and intermittent positive-pressure ventilation (IPPV) on arterial blood gases. Methods: This prospective randomized controlled study included patients presenting with out-of-hospital cardiac arrest who were randomly assigned to the CCSV or IPPV groups. Arterial blood gas analysis was performed at the start of CPR and 10 min after initiating mechanical ventilation. Primary outcomes included changes in the arterial oxygen and carbon dioxide pressures. Results: Of the 144 patients with out-of-hospital cardiac arrest, 30 were included in the study, with 15 each assigned to the CCSV and IPPV groups. The median arterial oxygen pressure in the CCSV group was 76.1 [22.8; 260.3 interquartile range], compared with 8.8 [-1.6; 113.9 interquartile range] in the IPPV group (p = 0.250). The change in carbon dioxide pressure was -10.3 [-18.3; -2.7 interquartile range] in the CCSV group and -11.5 [-39.5; 5.6 interquartile range] in the IPPV group (p = 0.935). Wilcoxon signed-rank test results revealed significant differences in arterial oxygen and carbon dioxide pressure levels before and after treatment in the CCSV group (p = 0.026 and 0.048, respectively). However, in the IPPV group, changes in arterial partial pressure of oxygen and carbon dioxide before and after treatment were non-significant (p = 0.095 and 0.107, respectively). Conclusions: Although CCSV significantly improved oxygenation and ventilation in patients undergoing CPR, it cannot be considered superior to IPPV.

Keywords: cardiac arrest; cardiopulmonary resuscitation; mechanical ventilation; oxygen; pressure.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Principle of chest compression synchronized ventilation (CCSV). During chest compressions without ventilatory assistance, the heart is compressed, pushing blood through the aorta (red arrow), while the lungs are also compressed, causing air to be expelled through the airway (blue arrow). In the CCSV mode, ventilatory support is synchronized with chest compressions, increasing intrathoracic pressure at the moment of compression. This synchronization enhances blood ejection, thereby improving circulatory effectiveness.
Figure 2
Figure 2
Study protocol. ABGA, arterial blood gas analysis; CCSV, chest compression-synchronized ventilation; IPPV, intermittent positive-pressure ventilation; PaO2, partial pressure of arterial oxygen; PaCO2, partial pressure of arterial carbon dioxide.
Figure 3
Figure 3
Study flow diagram. ABGA, arterial blood gas analysis; CCSV, chest compression-synchronized ventilation; IPPV, intermittent positive-pressure ventilation; ROSC, return of spontaneous circulation.
Figure 4
Figure 4
Partial pressure of arterial oxygen (PaO2) according to the ventilation method. ABGA, arterial blood gas analysis; CCSV, chest compression-synchronized ventilation; IPPV, intermittent positive-pressure ventilation; PaO2, partial pressure of arterial oxygen.
Figure 5
Figure 5
Partial pressure of arterial carbon dioxide (PaCO2) according to the ventilation method. ABGA, arterial blood gas analysis; CCSV, chest compression-synchronized ventilation; IPPV, intermittent positive-pressure ventilation; PaCO2, partial pressure of arterial carbon dioxide.
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