A 65-year-old male patient had a witnessed collapse and severe chest pain. The ambulance service initiated manual CPR. Initial rhythm strip analysis demonstrated asystole. After eight minutes, the fire service arrived at the site. Following 20 minutes of manual CPR, an MCCD and a resuscitator were attached (Figure 6 ).\nVentilation frequency varied around 100 breaths per minute, despite being attached to an MCCD and resuscitator. For approximately 36 seconds there was a decrease in the respiratory rate to 40 breaths per minute. This may be due to a leak in airway management, airway obstruction or the patient requiring a higher airway pressure than 15 cm H2O. Smaller variances in the respiratory rate (down to approx. 95 br/min for some seconds) occurred several times. Nevertheless, the etCO2 was almost constant around 40 mmHg. Epinephrine was administered several times. After 24 minutes of CPR, the patient had ROSC and was transported to a nearby hospital. A pulmonary embolism was diagnosed, and despite thrombolysis, the patient was subsequently declared deceased.
A 64-year-old unconscious male patient with cardiac arrest. The time between EMS notification and arrival of the fire service was eight minutes. An MCCD and a facemask together with a resuscitator were attached, and CPR was commenced.\nFigure 2 illustrates fifteen minutes of continuous CPR. Interruptions in the recording reflect interruptions in CPR during heart rhythm analysis and endotracheal intubation. The oxygen saturation ranged between 80–97%; however recordings included accidental removal of the pulse oximeter finger clip, poor circulatory status, hypothermia and vasoconstrictive medications. The etCO2 remained between 20 and 30 mmHg, which suggests sufficient CPR. EtCO2 increased after each interruption in CPR, as the CO2 accumulates due to decreased exhalation and lack of blood circulation. Defibrillation was not indicated, and upon arrival of the physician-staffed ambulance service, the patient was intubated and epinephrine administered. After 27 minutes, CPR was discontinued and the patient was declared deceased.