Mark et al. International Journal of Emergency Medicine 2012, 5:7 http://www.intjem.com/content/5/1/7 body temperature below 27°C. The latter estimate also corresponds to a decrease in cerebral blood flow to 40% of normal, which was observed in pigs undergoing exter- nal manual cardiac compression during normothermic circulatory arrest [9]. Although uninterrupted cardiac compression from the scene of the accident might have satisfied most of the patient’s oxygen demand until he was connected to CPB, acidosis made likely that he had suffered some degree of hypoxia. Moreover, the fact that relatively high doses of norepinephrine, pitressin, and milrinon were necessary to wean him off CPB, even with a low systemic arterial pressure, suggests that he was sub- jected to “rewarming shock.” It is believed that this type of circulatory failure, which has been observed in various species after hypothermia and rewarming, and often with a fatal outcome, is associated with intracellular Ca2+ overload [10]. However, the exact mechanism of this dys- function of intracellular ion transport remains unsettled. High serum levels of myoglobin and CPK indicate that the patient had a rhabdomyolysis that, most likely, trig- gered his renal and hepatic failures in concert with dis- seminated intravascular coagulation [11]. Thus, including a transient central nervous impairment and respiratory failure, our patient suffered at least five organ failures. However, in addition to a complete phy- sical and mental recovery, he has also adopted a heal- thier lifestyle. Conclusion To the best of our knowledge, 6 h 52 min is the longest time reported until the return of spon-taneous circula- tion and recovery without physical or mental sequelae after hypothermic cardiac arrest. We believe that well- integrated pre-hospital as well as local and university hospital medical services were important prerequisites for the successful outcome of this patient. Consent Written informed consent was obtained from the patient for publication of this case report. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Abbreviations CPB: cardiopulmonary bypass; CPR: cardiopulmonary resuscitation; ECG: electrocardiogram; IV: intravenously; UNN: University Hospital of North Norway; VF: ventricular fibrillation Acknowledgements We thank the emergency medical technicians Tone Rygh and Anders Samuelsen for initiating the treatment of the patient from the scene of accident; the dispatch center nurse, Mrs Lotte Niel, for coordinating the transfer of the patient to the University hospital; and helicopter pilot Tommy Kraknes and rescuer Stig Hansen. Page 3 of 3 Author details 1Department of Emergency Medical Services, University Hospital of North Norway, Trom-sø, Norway 2Department of Anesthesiology, University Hospital of North Norway, Tromsø, Norway 3Department of Thoracic and Cardiovascular Surgery, University Hospital of North Norway, Tromsø, Norway 4Department of Medical Engineering, University Hospital of North Norway, Tromsø, Norway 5Department of Medicine, Stokmarknes Hospital, Stokmarknes, Norway 6Anesthesia and Critical Care Research group, Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway Authors’ contributions EM was the anesthesiologist on board the helicopter, conceived the idea for and drafted the case report. OJ was the nurse anaesthetist on board the helicopter, AK and TN were cardiac anaesthesiologists on duty, RB and RB were thoracic surgeons, JKJ was the perfusionist, and PKS was in charge of treatment at the local hospital. LJB wrote and formatted the manuscript. 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