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 65-year-old male patient was found collapsed. The case was initially managed by a paramedic ambulance team. Manual CPR was performed for nine minutes, and a laryngeal mask was inserted. Initial rhythm analysis showed ventricular fibrillation, and the patient was defibrillated three times. Upon arrival of the fire service, an MCCD and a resuscitator were attached. SpO2 and etCO2 were measured and recorded.\nFigure 1 illustrates the first three minutes of resuscitation by the fire service prior to the attachment of the MCCD. In this initial period, ventilation was matched to manual chest compression. The respiration frequency varied with the manual CPR, ranging between 75 and 100 breaths per minute. EtCO2 was 20 mmHg for the first 30 seconds and then increased to 40 mmHg for the remainder of the recording. After 25 minutes of CPR, return of spontaneous circulation (ROSC) occurred and the patient was transported to a nearby hospital.