CAvent-Ventilation During Advanced Cardiopulmonary Resuscitation in Out-of-hospital Cardiac Arrest- an Observational Study
Conditions: Out-of-Hospital Cardiac Arrest, Pulmonary Ventilation
Sponsor: Uppsala University

 
Ventilation during advanced cardiopulmonary resuscitation in out-of-
hospital and in-hospital cardiac arrests – an observational study.  
 
Sponsor: 
Department of Surgical Sciences/Anaesthesiology & Intensive Care Medicine, Uppsala University 
 
Principal investigator: 
Professor Sten Rubertsson 
 
NCTNCT04237727 
 
2024-05-27 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
Table of Contents 
 
Table of Contents................................................................................................................................2 
1. Summary/Abstract ..........................................................................................................................3 
1.2 Criteria for inclusion ..................................................................................................................3 
1.3 Criteria for exclusion .................................................................................................................3 
2. List of abbreviations and definitions of terms ..................................................................................4 
3. Background .....................................................................................................................................4 
4. Primary and secondary endpoints ...................................................................................................5 
4.1 Primary endpoint ......................................................................................................................5 
4.2 Secondary endpoints .................................................................................................................5 
5. Study population .............................................................................................................................5 
5.1 Timetable ..................................................................................................................................6 
5.2 Criteria for inclusion ..................................................................................................................6 
5.3 Criteria for exclusion .................................................................................................................6 
6. Method ...........................................................................................................................................6 
6.1 Setting.......................................................................................................................................6 
6.1.1 Uppsala ..............................................................................................................................7 
6.1.2 Utrecht The Netherlands ....................................................................................................7 
6.1.2 Ambulance Amsterdam, the Netherlands ...........................................................................7 
6.1.3 Dalarna County ...................................................................................................................7 
6.1.4 Västmanland County ..........................................................................................................7 
6.1.5 Stockholm metropolitan area .............................................................................................7 
6.1.6 Uppsala University Hospital ................................................................................................8 
6.1.7 Karolinska University Hospital.............................................................................................8 
6.1.8 Falun County Hospital .........................................................................................................8 
6.2 Training .....................................................................................................................................8 
6.3 Equipment ................................................................................................................................8 
7. Implementation ..............................................................................................................................8 
7.1 Documentation of patient data & CRF .......................................................................................9 
7.2 Patient monitoring ....................................................................................................................9 
8. Safety..............................................................................................................................................9 
9. Monitoring ......................................................................................................................................9 
9.1 Source data ............................................................................................................................. 10 
10. Data Collection ............................................................................................................................ 10 

 
 
11. Ethical considerations ................................................................................................................. 10 
12. Statistical considerations ............................................................................................................. 10 
13. Insurance of patients included in the study ................................................................................. 10 
14. Publication policy ........................................................................................................................ 11 
15. Steering committee ..................................................................................................................... 11 
16. References .................................................................................................................................. 11 
 
 
1. Summary/Abstract  
The aim with this descriptive multicentre study is to examine the quality of the ventilation given by 
pre-hospital Emergency Medical Service (EMS) personnel and emergency team personnel in-hospital 
during cardiopulmonary resuscitation (CPR). It will consist of two parts. One examining the 
ventilation in Out-of-hospital cardiac arrests (OHCA) and one examining the ventilation in In-hospital 
cardiac arrests (IHCA). 
Primary endpoint is the ventilation quality measured as ventilation frequency, peak airway pressure, 
tidal volume, and minute ventilation.  
In OHCA: s this will be studied in patients receiving either 30:2 CPR with a supraglottic airway (SGA) 
or CPR with continuous ventilations with an endotracheal tube (ET) given during ongoing chest 
compressions. 
In IHCA:s this will be studied in patients receiving continuous ventilations with an ET given during 
ongoing chest compressions. 
The inclusion of patients in the OHCA part will be performed at multiple sites: Uppsala, Dalarna 
County, Västmanland county, Stockholm metropolitan area; Sweden and Amsterdam and Utrecht; 
The Netherlands). OHCA patients will receive standard care according to current CPR guidelines using 
manual or mechanical chest compressions.  
Inclusion of patients in the IHCA part will be performed at Uppsala University Hospital in Uppsala, 
Karolinska University Hospital in Stockholm, and Falun County Hospital in Falun. IHCA patients will 
also receive standard care according to current CPR guidelines. 
 
1.2 Criteria for inclusion  
Out of hospital cardiac arrest treated with cardiopulmonary resuscitation performed by the 
emergency medical services and in hospital cardiac arrest treated with cardiopulmonary 
resuscitation performed by emergency team personnel. 
1.3 Criteria for exclusion 
- 
Patient age < 18 years. 
- 
Known pregnancy. 
 

 
 
2. List of abbreviations and definitions of terms  
CABG 
Coronary Artery Bypass Grafting 
CPR 
Cardiopulmonary Resuscitation 
CPC 
Cerebral Performance Categories  
CRF 
Case Report Form 
EMR  
Electronic Medical Records 
EMS  
Emergency Medical Service 
ET 
Endotracheal tube 
etCO2 
End Tidal Carbon Dioxide 
GCP 
Good Clinical Practice 
GDPR 
General Data Protection Regulation 
GOS-E 
Extended Glasgow Outcome Scale 
I-Gel 
Supraglottic Airway device 
ICD 
Implantable Cardioverter Defibrillator 
IHCA 
In-hospital cardiac arrest 
LUCAS 
Mechanical Chest Compression System 
mRS 
Modified Rankin Scale 
OHCA 
Out-of-hospital cardiac arrest 
PCI 
Percutaneous Coronary Intervention 
ROSC 
Return of Spontaneous Circulation 
SGA  
Supraglottic airway 
SCA 
Sudden Cardiac Arrest 
 
3. Background  
In Europe approximately 500 000 people per year are affected by sudden cardiac arrests (SCA) and it 
is one of the leading causes of death (1). CPR with external chest compressions, has been the 
standard resuscitative measure since the beginning of the 1960´s (2). Despite progress in research 
and interventions most patients do not survive an OHCA (3), although the 30 days survival, in 
Sweden, after a SCA under the last decade has doubled resulting in a survival rate at 11% in 2017 (4). 
An analysis of OHCA outcome in 27 countries in Europe presented rates of Return of Spontaneous 
Circulation (ROSC) from less than 10.0% up to 50.0% and hospital survival ranging from less than 
5.0% up to 30.0%. The cause of this variance may be due to different EMS structures, CPR standards 
or due to differences in how the occurrence of ROSC has been perceived and registered in different 
regions in Europe (5).  

 
 
The survival rate for IHCA is significantly higher, with 37% of the patients alive after 30-days in 
Sweden 2019. This in part because ICHA: s receives CPR much earlier than OHCA: s. In 90% of the 
cases in Sweden 2019, CPR was started within 1 minute of the cardiac arrest (6). 
The field of IHCA has received considerably less attention than OHCA, and most of the patients 
affected still do not survive (7). Many variables in the treatment in IHCA therefore remains 
unexplored and in need of investigation, among them the ventilation. 
High quality CPR is crucial for maximizing survival and several studies have displayed the importance 
of early defibrillation, high quality chest compressions and minimizing interruptions of chest 
compressions but not only the quality of these components but also the timing is vital. Since 2010 
the gold standard of the ratio between compressions and ventilations has been 30:2 although when 
a SGA or an ET have been inserted the patient can be ventilated at a rate of 10 breaths/min with 
continuous chest compressions at the rate of 100-120/min (8-11). One concern is the theoretical risk 
that during periods of continuous chest compressions the ventilation might be compromised, a 
higher intrathoracic pressure generated by chest compressions may impede airflow to the lungs and 
when combined with a SGA leading to a higher risk for air leakage (12).   
During ongoing CPR, there are not many ways to measure the efficacy of CPR. It has been postulated 
that end tidal carbon dioxide (etCO2) could serve as a pseudo marker for the quality of CPR due to its 
correlation with pulmonary blood flow and cardiac output (13). Measurement of etCO2 is therefore a 
validated method but due to lack of definitive data on the best form of ventilatory support and 
technological restrictions to collecting valid etcCO2 during cardiac arrest one should be cautious 
when using the data in clinical situations (12). It has never been elucidated how the different CPR 
techniques (i.e., mechanical chest compressions versus manual chest compressions or continuous 
ventilation versus ventilation during pauses) affects the ventilation quality or etCO2 and therefor the 
primary goal of this descriptive study is to evaluate the ventilation achieved during CPR performed by 
EMS personnel.  
4. Primary and secondary endpoints 
4.1 Primary endpoint 
Primary endpoint is the ventilation quality measured as the ventilation frequency, peak airway 
pressure, tidal volume, and minute ventilation. 
4.2 Secondary endpoints  
The secondary endpoints are values or measurements that could be connected or affected by 
ventilation quality including: 
- 
etCO2 variation in relation to different modes of compression/ventilation (30:2 and 
ventilation during ongoing compressions). 
- 
Variances in inspiration time.  
- 
Fraction of dead space ventilation. 
- 
Differences in the above-mentioned parameters between OHCA and IHCA 
- 
Differences in the above-mentioned parameters between intubated patients with ventilation 
during ongoing compressions and patients with a supraglottic airway with 30:2 CPR. 
5. Study population 
The study population will be patients who have suffered an OHCA with CPR started by EMS personnel 
in Uppsala, Dalarna County, Västmanland County, and Stockholm metropolitan area; Sweden and 

 
 
Amsterdam and Utrecht; The Netherlands and patients who have suffered an IHCA in Uppsala; 
Sweden, Stockholm; Sweden and Falun; Sweden. 
5.1 Timetable 
- 
OHCA part start Q1 2019. 
- 
IHCA part start Q4 2022 
- 
End of inclusion Q4 2024 
5.2 Criteria for inclusion 
OHCA treated with CPR performed by EMS personnel and IHCA treated with CPR performed by 
emergency team personnel. 
5.3 Criteria for exclusion 
- 
Patient age < 18 years. 
- 
Known pregnancy. 
6. Method 
The study will be a prospective descriptive multicentre study where measurement of ventilation data 
will be sampled during CPR.  
The study will consist of two parts. One with OHCA: s and one with IHCA: s. 
The first part will include OHCA patients treated by the EMS service staffed by registered nurses and 
where CPR using the 30:2 method with an SGA variant called I-GEL is used. It will also include OHCA 
patients treated by an EMS rapid response unit staffed with anaesthesiologists where an ET is used, 
and ventilations are given continuously during ongoing chest compressions. The second part will 
include IHCA patients treated by emergency teams consisting of anaesthesiologists and nurse 
anaesthesiologists where an ET is used, and ventilations are given continuously during ongoing chest 
compressions. 
Data regarding care during and after the cardiac arrest will be obtained from the Swedish CPR 
registry. 
Data regarding hospital care and standard laboratory tests related to ventilation quality will be 
obtained from the patient medical journal systems. Outcome measures will be any ROSC, survival, 
and neurological outcome (CPC) measured at hospital discharge, 30 days and at 6 months. 
The inclusion will run until the end of 2024. If the goal of 400 patients in the OHCA part and 200 in 
the IHCA part is reached before the end of 2024, the inclusion will stop by that time. 
The study has been preceded by a trial period to solve any logistic and technical problems and will be 
registered at Clinicaltrials.gov before its initiation. 
6.1 Setting 
The inclusion of patients for the OHCA part will be performed at multiple sites (Uppsala, Dalarna 
County, Västmanland County, Stockholm metropolitan area; Sweden and Amsterdam and Utrecht; 
The Netherlands), all of the sites have the LUCAS device in their protocol for cardiac arrest and have 
implemented a specific algorithm, order of priority, while working with the LUCAS device. The 
algorithm which is in accordance with current guidelines will be presented as an attachment to the 
study. 

 
 
The inclusion of patients for the IHCA part will be performed at Uppsala University Hospital in 
Uppsala, Sweden, Karolinska University Hospital in Stockholm, Sweden and Falun County Hospital in 
Falun, Sweden. 
6.1.1 Uppsala 
Uppsala is the capital of Uppsala County and the fourth largest city in Sweden. Uppsala has 
approximately 210 000 residents (2017). The EMS service of Uppsala County has 13 ambulances 
covering 24 hours a day, seven days a week. Six of these are based in the city of Uppsala. 
Additionally, five ambulances are in service during office hours on weekdays. The EMS personnel in 
all ambulances consists of at least one nurse, in most cases (90%) a specialized nurse with additional 
education in emergency and ambulance care, anaesthesia or intensive care. The city of Uppsala has 
about 80 employees consisting of nurses, specialized nurses, and assistant nurses. 
6.1.2 Utrecht, the Netherlands 
Utrecht is the fourth largest city in The Netherlands and the city of Utrecht is the capital of the 
Utrecht Province. The Utrecht province has app. 1.3 million residents (2017).  EMS provides 24/7 
prehospital care for all inhabitants in the Utrecht province. The public can call the dispatch centre via 
telephone number 1-1-2 in case of any emergencies.  There is 1 dispatch centre and there are 11 
Ambulance-stations for 46 Ambulances, 15 fast responder Cars and 6 fast responder Motor bikes. 
The EMS personnel in all ambulances consists of one driver and one nurse, all the nurses are 
specialized nurses with additional education in emergency and ambulance care, anaesthesia, or 
intensive care. Utrecht has about 160 specialized nurses and 130 ambulance drivers. 
6.1.2 Ambulance Amsterdam, the Netherlands   
Amsterdam is the capital city of the Netherlands, situated in the province of North-The Netherlands. 
Amsterdam city has approximately 896 000 residents (2023). Ambulance Amsterdam provides all 
prehospital care as emergency medical service for all inhabitants, 24/7. The public can call the 
dispatch center via national telephone number 1-1-2 in case of any emergency. There is 1 regional 
dispatch center and there are 8 EMS stations. The station on the west side of the city center is the 
most centrally positioned station in Amsterdam, and attends the highest rate of OHCA of all 
Ambulance Amsterdam stations of Ambulance Amsterdam. It provides care with 7 advanced life 
support ambulances. The EMS personnel in all ambulances consists of one driver and one nurse, all 
the nurses are specialized nurses with additional education in emergency and ambulance care, 
anesthesia or intensive care. Ambulance post West employs about 60 specialized ambulance nurses. 
6.1.3 Dalarna County 
Dalarna County has a population of approximately 280 000. There are two larger cities in the county, 
Borlänge and Falun where roughly 40 % of the population lives. The EMS service in Dalarna consist of 
11 stations with 18 ambulances in service 24/7. They are staffed with at least one nurse, often 
specialized in emergency and ambulance care, anesthesia or intensive care. 
6.1.4 Västmanland County 
Västmanland county has around 280 000 inhabitants with Västerås being the largest city where 
approximately 56% of the county’s population lives. The EMS service in Västerås county consists of 4 
stations and 16 ambulances in service 24/7. They are staffed with at least one nurse, often 
specialized in emergency and ambulance care, anesthesia, or intensive care. 
6.1.5 Stockholm metropolitan area 
Stockholm is the capital of Sweden with approximately 2.5 million inhabitants in the metropolitan 
area. The area is served by over 80 ambulances as well as two helicopters and three non-transporting 

 
 
rapid response units staffed by physicians (specialized in anesthesiology or emergency medicine) and 
nurse anesthetists. Of these, one is in service 24/7. These special units mainly respond to serious 
conditions such as cardiac arrests and major trauma. 
6.1.6 Uppsala University Hospital 
Uppsala university hospital is one of Sweden’s largest hospitals with 8000 employees and 
approximately 940 beds. The emergency teams that respond to cardiac arrest alarms consist of 
anaesthesiologists and nurse anaesthesiologists. 
6.1.7 Karolinska University Hospital 
Karolinska University Hospital in Solna, Stockholm, Sweden is one of Stockholm’s five metropolitan 
hospitals. It has 550 beds and 6000 employees. The emergency teams that respond to cardiac arrest 
alarms consist of anaesthesiologists and nurse anaesthesiologists. 
6.1.8 Falun County Hospital 
Falun county hospital is the county hospital of Dalarna County. It has 3300 employees and 500 beds. 
The emergency teams that respond to cardiac arrest alarms consist of anaesthesiologists and nurse 
anaesthetists. 
6.2 Training 
All EMS and emergency team personnel (Sweden) are obliged to participate in annual CPR training 
sessions per standards of Swedish CPR council. All Dutch EMS personnel are obliged to participate in 
at least three CPR training sessions per standards and guidelines of Dutch CPR council. 
All personnel responsible for the inclusion of patients will undergo a theoretical and practical training 
program to ensure that they can perform measurements of ventilation markers in a secure and 
correct way. The personnel, that have been working with the Flux Med device prior to the study, 
have received individual instructions in how to use the equipment.  
6.3 Equipment 
The Flux Med device with the ability to measure ventilation parameters will be used in the study. In 
complement to the Flux Med a computer (Microsoft surface) will be connected to collect and save 
ventilation values. The equipment will be carried in a special bag appropriated for the prehospital 
setting. A routine for maintaining and configurating the equipment has been created. A description 
of the device and routine for application and configuration will be presented as an attachment to the 
study. The device has been implemented in the clinical setting and has therefore been in use prior to 
the start of the study.  
 
7. Implementation 
In the OHCA part the FluxMed device and the computer, will be carried in a special bag by the EMS 
personnel in complement with the other equipment used when performing CPR. In OHCA the EMS 
personnel carrying the Flux Med device will oversee the airway management. The personnel will 
follow the current standards for CPR and priority order while working with the LUCAS device. When 
either the SGA is successfully placed or the patient is intubated with an ET, the FluxMed will be 
started and a mainstream sensor, placed between the SGA/ET and bag valve mask, will automatically 
sample ventilation parameters. All OHCA patients will receive care according to current guidelines, 
which includes chest compressions, ventilation, defibrillation, and the use of Epinephrine and 
Amiodarone. 

 
 
The standard compression to ventilation ratio used in the prehospital setting is 30:2. In the cases 
where the patient is intubated by the rapid response unit ventilations will be given continuously 
during ongoing compressions. 
In the IHCA part, the FluxMed device and the computer will be carried in a special bag by the 
emergency teams that responds to cardiac arrest alarms inside the hospital. The bag will be mounted 
on a bike that the personnel use to get to the patient. When they reach the patient, they will 
continue the CPR that the ward staff has already started. They will then perform an endotracheal 
intubation and connect the FluxMed to the tube. When the intubation is done, the CPR will continue 
with continuous chest compressions and 8-10 ventilations per minute. 
 
7.1 Documentation of patient data & CRF 
The personnel will use the current electronic medical record (EMR) system available in the 
ambulance organizations and in the hospitals for documenting and keeping patient records. In 
addition, they will also use a case report form (CRF). All the questions in the CRF must be answered, if 
the question can´t be answered the alternatives ND=not done, NA=not applicable or NK=Not known 
can be used. 
7.2 Patient monitoring 
Monitoring of OHCA patients included in the study will be performed by the responsible investigator. 
Monitoring will be performed by obtaining data from the Swedish CRP registry and by checking the 
patient records for ROSC, post cardiac arrest care, survival rate including neurologic outcome 
measured using CPC and mRS at discharge, 30 days and at 6 months using GOS-E.  
Monitoring of post cardiac arrest treatment will also be conducted, and we will check for eventual 
implantable cardioverter defibrillator (ICD) insertions, coronary artery bypass grafting (CABG), 
percutaneous coronary intervention (PCI) and treatment with targeted temperature management. 
 
8. Safety 
No safety risks have been acknowledged while using the Flux Med prior to the planning of the study.  
Eventual deviations that are brought to attention, while using the Flux Med device, regarding patient 
safety will be reported to responsible investigators and reported according to current regulations 
stipulated in the respective ambulance organizations. 
 
9. Monitoring 
Monitoring of data will be performed by the responsible sponsor and performed by research nurses 
employed at Uppsala University Hospital and personnel from Uppsala Clinical Research according to 
Good Clinical Practice (GCP). 
An independent monitor shall ensure that:  
- 
The protocol is followed according to set standards.  
- 
The recruitment and inclusion of patient follows the study plan.  
- 
The correct data are collected for the CRF which been assembled for the study. 
- 
The needed resources are available for implementation of all parts to answer the study’s 
endpoints.  

 
 
The principal investigator shall ensure that the independent monitor have access to CRF, patient 
records and blood samples/laboratory data originals etc. to ensure that the correct data are 
documented for the study, without any risk for the patient’s integrity.   
9.1 Source data 
Data in the CRF will be controlled so that the patient data are confirmed with the data documented 
in the patient records.  
 
10. Data Collection 
A database will be established and maintained by the responsible investigators in this study. Principal 
investigator is Sten Rubertsson.  
The included patients name, and social security number will be replaced in the database with a code. 
A keycode will be kept protected to ensure that the patients’ identities are protected from 
unauthorized persons. All documents related to this study will be kept in such a way that information 
regarding included patients is safe from unauthorized persons and controlled according to the 
general data protection regulation (GDPR) which purpose is to ensure that all EU citizens data privacy 
are protected. The Dutch general data protection regulation is followed in The Netherlands and quite 
similar to the Swedish regulations.  
  
11. Ethical considerations 
There are several reasons why the patients who suffered from a SCA are to be included in scientific 
examinations. The mortality is, in defiance to new guidelines and research, still high and therefore 
there is humanitarian as well as scientific reasons to continue to pursue ways to improve survival. 
Otherwise, there is a risk that this group of patients are excluded from the possibility to a better 
outcome which can be considered unethical.  
 
12. Statistical considerations 
As this study will be a descriptive study no power analysis has been performed. 
Continuous variables will be reported as means and SDs or medians and IQRs and categorical 
variables as proportions. Dichotomous outcomes will be compared using χ2 tests or Fisher's exact 
test when appropriate. Continuous outcomes will be compared with independent samples using 
the t test or the non-parametric Mann-Whitney U test if variables are not normally distributed. We 
will use the Kaplan-Meier method and log-rank test to compare survival curves from inclusion until 
30 days. 
 
13. Insurance of patients included in the study 
Subjects in the study in Sweden are covered by the Swedish Patient Insurance. In other countries a 
similar insurance system will be applicable as in the Netherlands patient insurance is also mandatory. 
 

 
 
14. Publication policy 
After completion of the study, the statistical analyses will be performed by the investigators. Based 
on these data, the investigators, will prepare manuscripts intended for publication in 
medical/scientifical journals. 
 
15. Steering committee 
Sten Rubertsson MD, PhD, Professor, Uppsala, Sweden 
David Smekal MD, PhD, Uppsala, Sweden 
Johan Mälberg, RN, PhD student, Uppsala, Sweden 
Hans van Schuppen, MD, PhD, Amsterdam, the Netherlands   
Patrick Schober, MD, PhD, Professor, Amsterdam, the Netherlands  
Björn Ahlström, MD, PhD, Falun, Sweden 
Magnus Hedberg, MD, PhD, Stockholm, Sweden 
16. References 
1. Perkins G D, Handley A J, Koster R W, Castrén M, Smyth M A, Olasveengen T, Monsieurs K G, 
Raffay V, Gräsnerv J-T, Wenzel V, Ristagno G, Soar J. On behalf of the Adult basic life support 
and automated external defibrillation section Collaborators Bossaert L L, Caballero A, Cassan 
P, Granja C, Sandroni C, Zideman D A, Nolan J P, Maconochie I, Greif R. 
European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life 
support and automated external defibrillation. 
Resuscitation 2015;85:81-99. 
2. Acosta P, Varon J, Sternbach G L, Baskett P. Kouwenhoven, Jude and Knickerbocker: The 
introduction of defibrillation and external chest compressions in modern resuscitation. 
Resuscitation 2015;64:139-143. 
3. Hollenberg J, Svensson L, Rosenqvist M. Out of hospital cardiac arrest: 10 years of progress in 
research and treatment. J Intern Med, 2013;273(6):572-83.  
4. HLR rådet 2017. Hjärt-lungräddningsregistret årsrapport 2017. Stockholm: HLR rådet. 
http://www.hlr.nu/start/forskning/hjartstopp-utanfor-sjukhus. 
5. Gräsner J-T, Lefering R, Koster R W, Masterson S, B Baster B W, Herlitz, Ingvild JW,  
Tjelmeland B M, Ortiz F R, Maurer H, Baubin M, Mols P, Hadadsinndnd I, Š dads M I R, 
Wissenberg M, Salo A, Hubert H, Nikolaou N I, L LIk G, Svavarsdsdrgn H, Semeraro F, 
Wright P J, Clarens C, Pijls R, Cebula G, Correia V G, Cimpoesu D, Raffay V, Trenkler S, 
Markota A, Strrotaa A, Burkart R, Perkins G D, Bossaert L L. EuReCa ONE 27 Nations, ONE 
Europe, ONE Registry. A prospective one month analysis of out-of-hospital cardiac arrest 
outcomes in 27 countries in Europe. 
Resuscitation 2016;109:145-146. 
6. HLR rådet 2020. Hjärt-lungräddningsregistret årsrapport 2019. Stockholm: HLR rådet.  
https://www.hlr.nu/wp-content/uploads/2020/09/Svenska-HLR-registret-%C3%A5rsrapport-
2019-publicerad-2020.pdf 

 
 
7. Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: 
A Review. JAMA. 2019 Mar 26;321(12):1200–10. 
8. Kern K B, Hilwig R W, Berg R A, Sanders A B, Ewy G. Importance of continuous chest 
compressions during cardiopulmonary resuscitation improved outcome during a simulated 
single lay-rescuer scenario. Circulation 2002;105:645-9. 
9. Pollack R A, Brown S P, Rea T, Aufderheide T, Barbic D, Buick J E, Christensson J, Idris A H, 
Jasti J, Kampp M, Kudenchuk P, May S, Muhr M, Nichol G, Ornato J P, Sopko G, Vaillancourt 
C, Morrison L, Weisfeldt M. Impact of Automated External Defibrillator Use on Survival and 
Functional Outcomes in Shockable Observed Public Cardiac Arrest. Circulation Feb 26, 2018. 
10. Nolan J P et al. European Resuscitation Council Guidelines for Resuscitation 2010. 
Resuscitation 2010;81:1219-1276 
11. Perkins G D, Olasveengenian TM, Soar M J, Wyllie J, Greif R, Lockey A, Semeraro F, Van de 
Voorde P, Koenraad C L, Monsieurs G, Nolan JP. 
European Resuscitation Council Guidelines for Resuscitation: 2017 update 
Resuscitation 2018;123:43-50  
12. Beckera T K, Berningb A W, Clifton A P, Francis W C, Guyettec X, Martin-Gillc C. 
An assessment of ventilation and perfusion markers in out-of-hospital cardiac arrest patients 
receiving mechanical CPR with endotracheal or supraglottic airways. 
Resuscitation 2018;122:61-64 
13. Axelsson C, Karlsson T, Axelsson Å B, Herlitz J. Mechanical active compression-decompression 
cardiopulmonary resuscitation (ACD-CPR) versus manual CPR according to pressure of end 
tidal carbon dioxide (PetCO2) during CPR in out-of-hospital cardiac arrest (OHCA). 
Resuscitation 2009;80:1099-1103