CCSV versus CC+SI: Comparing Two Innovative Neonatal CPR Strategies 🫁❤️👶

https://www.youtube.com/watch?v=X_bdQV4uzvc

Over the last decade, our research program has focused on improving cardiopulmonary resuscitation (CPR) for newborn infants. Traditional neonatal CPR uses a 3:1 compression-to-ventilation ratio (3:1 C), but growing evidence suggests that alternative approaches may improve ventilation, circulation, and ultimately outcomes during resuscitation.

Two promising techniques that have emerged from this work are:

• Chest Compressions with Sustained Inflation (CC+SI)

• Chest Compression Synchronized Ventilation (CCSV)

Both strategies aim to overcome some of the limitations of conventional neonatal CPR by improving ventilation during chest compressions. While previous studies demonstrated benefits of each approach compared with the traditional 3:1 Ctechnique, an important question remained:

Which of these two innovative CPR strategies performs better?

Why Compare CCSV and CC+SI?

Both approaches are designed to improve oxygen delivery and gas exchange during cardiac arrest, but they achieve this in different ways.

Chest Compressions with Sustained Inflation (CC+SI)

CC+SI combines continuous chest compressions with a prolonged inflation pressure delivered to the lungs. During chest recoil, air passively re-enters the lungs, helping maintain lung recruitment and improve ventilation throughout CPR.

Chest Compression Synchronized Ventilation (CCSV)

CCSV uses a ventilator that detects each chest compression and automatically delivers a synchronized inflation. This creates an inflation-compression cycle with every chest compression, potentially optimizing both ventilation and circulation.

Previous studies from our laboratory showed that both techniques improved physiological parameters compared with standard neonatal CPR. However, they had never been directly compared.

The Study

Using a well-established neonatal piglet model of asphyxial cardiac arrest, newborn piglets were:

• Anesthetized

• Intubated and instrumented

• Exposed to prolonged hypoxia followed by asphyxia

• Allowed to progress to asystolic cardiac arrest

Piglets were then randomized to receive either:

• CCSV

• CC+SI

Researchers continuously monitored respiratory and cardiovascular parameters throughout resuscitation.

What Did We Find?

Return of Spontaneous Circulation

The primary outcome was the time required to achieve return of spontaneous circulation (ROSC).

The results were remarkably similar:

• CCSV: 68 seconds (IQR 50–125)

• CC+SI: 71 seconds (IQR 60–178)

There was no significant difference between groups.

Survival

The proportion of animals achieving ROSC was also similar:

• CCSV: 75% (6/8)

• CC+SI: 63% (5/8)

Again, no statistically significant difference was observed.

Respiratory Performance

Although outcomes were similar, there were important physiological differences:

CCSV generated:

• Higher peak inflation pressures

• Lower positive end-expiratory pressures (PEEP)

Despite these differences, tidal volume delivery remained comparable between both approaches.

What Do These Findings Mean?

This study demonstrated that two very different ventilation strategies can achieve similar resuscitation outcomes during neonatal cardiac arrest.

Importantly:

✅ Both techniques achieved rapid ROSC

✅ Both maintained physiological stability

✅ Neither approach demonstrated a clear advantage over the other

These findings suggest that the beneficial effects observed with both strategies may stem from their shared ability to improve ventilation and maintain lung recruitment during chest compressions.

Building on Previous Research

Our previous studies demonstrated:

• Faster ROSC with CCSV compared with standard 3:1 C

• Faster ROSC with CC+SI compared with standard 3:1 C

• Improved ventilation and hemodynamics with both approaches

This study was therefore an important next step, directly comparing two leading physiology-based CPR techniques.

The results indicate that both approaches warrant further investigation and provide additional evidence that alternative ventilation strategies may outperform traditional neonatal CPR.

Looking Ahead

The ultimate goal of neonatal resuscitation research is to improve survival while reducing brain injury and long-term disability.

While this study did not identify a clear winner between CCSV and CC+SI, it demonstrated that both strategies can successfully support circulation and ventilation during neonatal cardiac arrest.

These findings continue to advance our understanding of neonatal CPR physiology and contribute to the growing body of evidence supporting innovative approaches to newborn resuscitation.

As translational research progresses from laboratory models to clinical studies, we move closer to answering one of the most important questions in neonatal medicine:

How can we provide the most effective CPR for newborn infants when every second matters?

We are very thankful to Weinmann for providing us with 2 ventilators to allow us to study this in Children, Infants, and Newborns.