Termination of cardiopulmonary resuscitation in mountain rescue

High Altitude Medicine and Biology

Volumn 13, Issue 3, 2012, Pages 200-208

  Paal, Peter ^a,b   Milani, Mario ^b,c   Brown, Douglas ^b,d   Boyd, Jeff ^b,e,g   Ellerton, John ^b,f  

^a UNIVERSITY HOSPITAL INNSBRUCK   (Austria)

^b International Commission for Mountain Emergency Medicine (ICAR MEDCOM)   (Italy)

^c A MANZONI HOSPITAL   (Italy)

^d UNIVERSITY OF BRITISH COLUMBIA   (Canada)

^e Banff Mineral Springs Hospital   (Canada)

^f Mountain Rescue Council (England and Wales) Pinfold   (United Kingdom)

^g International Federation of Mountain Guides ^*  (Canada)

Author keywords

cardiopulmonary resuscitation; cemergency medicine; death; first aid; mountain rescue

Indexed keywords

ADMINISTRATIVE PERSONNEL; AIRWAY OBSTRUCTION; AUTOLYSIS; AVALANCHE; CLINICAL PROTOCOL; CONFERENCE PAPER; DECAPITATION; ELECTROCARDIOGRAM; EMERGENCY MEDICINE; ENVIRONMENTAL FACTOR; EXHAUSTION; HEART ARREST; HUMAN; HYPOTHERMIA; INCINERATION; LAW; PATIENT TRANSPORT; PRIORITY JOURNAL; RESCUE PERSONNEL; RESCUE WORK; RESUSCITATION; RISK ASSESSMENT; TRAINING; VITAL SIGN;

CARDIOPULMONARY RESUSCITATION; HUMANS; MOUNTAINEERING; PRACTICE GUIDELINES AS TOPIC; RESCUE WORK; SAFETY; WITHHOLDING TREATMENT;

EID: 84866664931     PISSN: 15270297     EISSN: 15578682     Source Type: Journal    
DOI: 10.1089/ham.2011.1096     Document Type: Conference Paper

References (98)

1. Adhiyaman V. Adhiyaman S, and Sundaram R. (2007). The Lazarus phenomenon. J R Soc Med 100:552-557. (Pubitemid 351204433)
2. Anonymous. 2010. Avalanches Kill 7 in Northern Italy. In: New York Times.
3. Bailey ED, Wydro GC, and Cone DC. (2000). Termination of resuscitation in the pre-hospital setting for adult patients suffering nontraumatic cardiac arrest. National Association of EMS Physicians Standards and Clinical Practice Committee. Prehosp Emerg Care 4:190-195. (Pubitemid 30211226)
4. Barcella L, Agazzi G, Malgrati D, Sileo F, Calderoli A, Rottoli E, Valoti O, and Parigi GB. (2010). First aid and public access defibrillation in mountain huts: The Mountain Huts Initiative of the Bergamo section of the Club Alpino Italiano. Wilderness Environ Med 21:379-381.
5. Baskett PJ, Steen PA, and Bossaert L. (2005). European Resuscitation Council guidelines for resuscitation 2005. Section 8.
6. The ethics of resuscitation and end-of-life decisions. Resuscitation 67:S171-180.
7. Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, Lerner EB, Rea TD, Sayre MR, and Swor RA. (2010). Part 5: Adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122:S685-705.
8. Bolte RG, Black PG, Bowers RS, Thorne JK, and Corneli HM. (1988). The use of extracorporeal rewarming in a child submerged for 66 minutes. JAMA 260:377-379.
9. Boyd J, Brugger H, and Shuster M. (2010). Prognostic factors in avalanche resuscitation: A systematic review. Resuscitation 81:645-652.
10. Boyd JJ, Agazzi G, Svajda D, Morgan AJ, Ferrandis S, and Norris RL. (2007). Venomous snakebite in mountainous terrain: Prevention and management. Wilderness Environ Med 18:190-202. (Pubitemid 47536198)
11. Braun P, Herff H, and Paal P. (2011). The Lazarus phenomenon-False positive death certifications and auto-resuscitation cases covered in lay press. Resuscitation 82:1363-1364.
12. Brooks SC, Bigham BL, and Morrison LJ. (2011). Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev:CD007260.
13. Brugger H, Durrer B, Adler-Kastner L, Falk M, and Tschirky F. (2001). Field management of avalanche victims. Resuscitation 51:7-15.
14. Brugger H, Elsensohn F, Syme D, Sumann G, and Falk M. (2005). A survey of emergency medical services in mountain areas of Europe and North America: Official recommendations of the International Commission for Mountain Emergency Medicine (ICAR Medcom). High Alt Med Biol 6:226-237.
15. Brugger H, Paal P, and Boyd J. (2011). Pre-hospital resuscitation of the buried avalanche victim. High Alt Med Biol 12:199-205.
16. Brugger H, Sumann G, Meister R, Adler-Kastner L, Mair P, Gunga HC, Schobersberger W, and Falk M. (2003). Hypoxia and hypercapnia during respiration into an artificial air pocket in snow: Implications for avalanche survival. Resuscitation 58:81-88. (Pubitemid 36831071)
17. Burtscher M, Pachinger O, Mittleman MA, and Ulmer H. (2000). Prior myocardial infarction is the major risk factor associated with sudden cardiac death during downhill skiing. Int J Sports Med 21:613-615. (Pubitemid 32002977)
18. Burtscher M, Pachinger O, Schocke MF, and Ulmer H. (2007). Risk factor profile for sudden cardiac death during mountain hiking. Int J Sports Med 28:621-624. (Pubitemid 47080146)
19. Cherington M. (1995). Lightning injuries. Ann Emerg Med 25:517-519.
20. CNSAS. (2002-2008). [Corpo Nazionale Soccorso Alpino e Speleologico (CNSAS), Annual Reports 2002-2008].
21. Cooper MA. (1980). Lightning injuries: Prognostic signs for death. Ann Emerg Med 9:134-138.
22. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, and Perkins GD. (2010). European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 81:1305-1352.
23. Durrer B, Brugger H, and Syme D. (2003). The medical on-site treatment of hypothermia: ICAR-MEDCOM recommendation. High Alt Med Biol 4:99-103. (Pubitemid 36511804)
24. Durward A, Guerguerian AM, Lefebvre M, and Shemie SD. (2003). Massive diltiazem overdose treated with extracorporeal membrane oxygenation. Pediatr Crit Care Med 4:372-376.
25. Elsensohn F, Agazzi G, Syme D, Swangard M, Facchetti G, and Brugger H. (2006). The use of automated external defibrillators and public access defibrillators in the mountains: Official guidelines of the international commission for mountain emergency medicine ICAR-MEDCOM. Wilderness Environ Med 17:64-66. (Pubitemid 43375858)
26. Elsensohn F, Niederklapfer T, Ellerton J, Swangard M, Brugger H, and Paal P. (2009). Current status of medical training in mountain rescue in America and Europe. High Alt Med Biol 10:195-200.
27. Elsensohn F, Soteras I, Resiten O, Ellerton J, Brugger H, and Paal P. (2011). Equipment of medical backpacks in mountain rescue. High Alt Med Biol 12:343-347.
28. Ewy GA. (2006). Cardiac resuscitation - When is enough enough? N Engl J Med 355:510-512.
29. Farber NJ, Simpson P, Salam T, Collier VU, Weiner J, and Boyer EG. (2006). Physicians' decisions to withhold and withdraw life-sustaining treatment. Arch Intern Med 166:560-564.
30. Gilbert M, Busund R, Skagseth A, Nilsen PA., and Solbo JP. (2000). Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet 355:375-376.
31. Grudzen CR, Hoffman JR, Koenig WJ, Boscardin J, Lorenz KA, and Asch SM. (2010). The LA story: What happened after a new policy allowing paramedics to forgo resuscitation attempts in pre-hospital cardiac arrest. Resuscitation 81:685-690.
32. Hall WL, 2nd, Myers JH, Pepe PE, Larkin GL, Sirbaugh PE, and Persse DE. (2004). The perspective of paramedics about onscene termination of resuscitation efforts for pediatric patients. Resuscitation 60:175-187. (Pubitemid 38230909)
33. Hampson NB and Zmaeff JL. (2001). Outcome of patients experiencing cardiac arrest with carbon monoxide poisoning treated with hyperbaric oxygen. Ann Emerg Med 38:36-41. (Pubitemid 32606028)
34. Harries M. (2003). Near drowning. BMJ 327:1336-1338.
35. Hearns S. (2003). The Scottish mountain rescue casualty study. Emerg Med J 20:281-284. (Pubitemid 36617333)
36. Hohlrieder M, Brugger H, Schubert HM, Pavlic M, Ellerton J, and Mair P. (2007). Pattern and severity of injury in avalanche victims. High Alt Med Biol 8:56-61. (Pubitemid 46587449)
37. Hohlrieder M, Kroesslhuber F, Voelckel W, Lutz M, and Mair P. (2010). Experience with helicopter rescue missions for crevasse accidents. High Alt Med Biol 11:375-379.
38. Hopson LR, Hirsh E, Delgado J, Domeier RM, McSwain NE, and Krohmer J. (2003). Guidelines for withholding or termination of resuscitation in pre-hospital traumatic cardiopulmonary arrest: Joint position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. J Am Coll Surg 196:106-112. (Pubitemid 36071003)
39. Ibsen LM and Koch T. (2002). Submersion and asphyxial injury. Crit Care Med 30:S402-408.
40. Jeschke MG, Herndon DN, and Barrow R. E. (2000). Long-term outcomes of burned children after in-hospital cardiac arrest. Crit Care Med 28:517-520. (Pubitemid 30120899)
41. Koster RW, Baubin MA, Bossaert LL, Caballero A, Cassan P, Castren M, Granja C, Handley AJ, Monsieurs KG, Perkins GD, Raffay V, and Sandroni C. (2010). European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 81:1277-1292.
42. Koumbourlis AC. (2002). Electrical injuries. Crit Care Med 30:S424-430.
43. Krarup NH, Kaltoft A, and Lenler-Petersen P. (2010). Risen from the dead: A case of the Lazarus phenomenon with considerations on the termination of treatment following cardiac arrest in a pre-hospital setting. Resuscitation 81:1598-1599.
44. Larach MG. (1995). Accidental hypothermia. Lancet 345:493-498.
45. Layon AJ and Modell JH. (2009). Drowning: Update 2009. Anesthesiology 110:1390-1401.
46. Lim SH, Shuster M, Deakin CD, Kleinman ME, Koster RW, Morrison LJ, Nolan JP, and Sayre MR. (2010). Part 7: CPR techniques and devices: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 81 Suppl 1:e86-92.
47. Lippert FK, Raffay V, Georgiou M, Steen PA, and Bossaert L. (2010). European Resuscitation Council Guidelines for Resuscitation 2010 Section 10. The ethics of resuscitation and end-of-life decisions. Resuscitation 81:1445-1451.
48. Lloyd EL. (1996). Accidental hypothermia. Resuscitation 32:111-124. (Pubitemid 26317127)
49. Lockey AS. (2002). Recognition of death and termination of cardiac resuscitation attempts by UK ambulance personnel. Emerg Med J 19:345-347. (Pubitemid 34830494)
50. Lockey D, Crewdson K, and Davies G. (2006). Traumatic cardiac arrest: Who are the survivors? Ann Emerg Med 48:240-244. (Pubitemid 44278311)
51. Martin SK, Shatney CH, Sherck JP, Ho CC, Homan SJ, Neff J, and Moore EE. (2002). Blunt trauma patients with pre-hospital pulseless electrical activity (PEA): Poor ending assured. J Trauma 53:876-880; discussion 880-871.
52. McIntosh SE, Brillhart A, Dow J, and Grissom CK. (2010). Search and rescue activity on Denali, 1990 to 2008. Wilderness Environ Med 21:103-108.
53. McIntosh SE, Grissom CK, Olivares CR, Kim HS, and Tremper B. (2007). Cause of death in avalanche fatalities. Wilderness Environ Med 18:293-297.
54. Millin MG, Khandker SR, and Malki A. (2011). Termination of resuscitation of nontraumatic cardiopulmonary arrest: Resource document for the National Association of EMS Physicians position statement. Prehosp Emerg Care 15:547-554.
55. Modell JH. (1993). Drowning. N Engl J Med 328:253-256. (Pubitemid 23035312)
56. Mollberg NM, Wise SR, Berman K, Chowdhry S, Holevar M, Sullivan R, and Vafa A. (2011). The consequences of noncompliance with guidelines for withholding or terminating resuscitation in traumatic cardiac arrest patients. J Trauma 71:997-1002.
57. Moriwaki Y, Sugiyama M, Yamamoto T, Tahara Y, Toyoda H, Kosuge T, Harunari N, Iwashita M, Arata S, and Suzuki N. (2011). Outcomes from pre-hospital cardiac arrest in blunt trauma patients. World J Surg 35:34-42.
58. Morrison LJ, Deakin CD, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW, Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TL, Bottiger BW, Drajer S, Lim SH, and Nolan JP. (2010a). Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 122:S345-421.
59. Morrison LJ, Kierzek G, Diekema DS, Sayre MR, Silvers SM, Idris AH, and Mancini ME. (2010b). Part 3: Ethics: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122:S665-675.
60. Morrison LJ, Verbeek PR, Zhan C, Kiss A, and Allan KS. (2009). Validation of a universal pre-hospital termination of resuscitation clinical prediction rule for advanced and basic life support providers. Resuscitation 80:324-328.
61. Morrison LJ, Visentin LM, Kiss A, Theriault R, Eby D, Vermeulen M, Sherbino J, and Verbeek PR. (2006). Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest. N Engl J Med 355:478-487. (Pubitemid 44162275)
62. Moser B, Voelckel W, Gardetto A, Sumann G, and Wenzel V. (2005). One night in a snowbank: A case report of severe hypothermia and cardiac arrest. Resuscitation 65:365-368. (Pubitemid 40779347)
63. Nelson KL, Mills W, Jr., Umbel S, Crosson JE, Shaffner DH, and Hunt EA. (2007). Lightning, sudden cardiac death, simulation and an automated external defibrillator: The perfect storm. Resuscitation 74:567-571. (Pubitemid 47176767)
64. Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, and Morrison LJ (2010). Part 8: Adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122:S729-767.
65. Nolan JP, Hazinski MF, Billi JE, Boettiger BW, Bossaert L, de Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME, Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH, Morley PT, Morrison LJ, Nadkarni VM, O'Connor RE, Okada K, Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH, Wyllie J, and Zideman D. (2010). Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 81:e1-25.
66. Oberhammer R, Beikircher W, Hormann C, Lorenz I, Pycha R, Adler-Kastner L, and Brugger H. (2008). Full recovery of an avalanche victim with profound hypothermia and prolonged cardiac arrest treated by extracorporeal re-warming. Resuscitation 76:474-480. (Pubitemid 351200559)
67. Ong ME, Jaffey J, Stiell I, and Nesbitt L. (2006). Comparison of termination-of-resuscitation guidelines for basic life support: Defibrillator providers in out-of-hospital cardiac arrest. Ann Emerg Med 47:337-343.
68. Paal P, Beikircher W, and Brugger H. (2006). [Avalanche emergencies. Review of the current situation]. Anaesthesist 55:314-324.
69. Perkins GD. (2011). Rescue and resuscitation or body retrieval: The dilemmas of search and rescue efforts in drowning incidents. Resuscitation 82:799-800.
70. Pickens JJ, Copass MK, and Bulger EM. (2005). Trauma patients receiving CPR: Predictors of survival. J Trauma 58:951-958. (Pubitemid 40776898)
71. Ponchia A, Biasin R, Tempesta T, Thiene M, and Volta SD. (2006). Cardiovascular risk during physical activity in the mountains. J Cardiovasc Med (Hagerstown) 7:129-135. (Pubitemid 44152953)
72. Powner DJ, Ackerman BM, and Grenvik A. (1996). Medical diagnosis of death in adults: Historical contributions to current controversies. Lancet 348:1219-1223. (Pubitemid 26361612)
73. Putzer G, Schmid S, Braun P, Brugger H, and Paal P. (2010). Cooling of six centigrades in an hour during avalanche burial. Resuscitation 81:1043-1044.
74. Richman PB, Vadeboncoeur TF, Chikani V, Clark L, and Bobrow BJ. (2008). Independent evaluation of an out-of-hospital termination of resuscitation (TOR) clinical decision rule. Acad Emerg Med 15:517-521.
75. Ritenour AE, Morton MJ, McManus JG, Barillo DJ, and Cancio LC. (2008). Lightning injury: A review. Burns 34:585-594.
76. Rodway GW, McIntosh SE, and Dow J. (2011). Mountain research and rescue on Denali: A short history from the 1980s to the present. High Alt Med Biol 12:277-283.
77. Ruttmann E, Weissenbacher A, Ulmer H, Muller L, Hofer D, Kilo J, Rabl W, Schwarz B, Laufer G, Antretter H, and Mair P. (2007). Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest. J Thorac Cardiovasc Surg 134:594-600. (Pubitemid 47301967)
78. Ruygrok ML, Byyny RL, and Haukoos JS. (2009). Validation of 3 termination of resuscitation criteria for good neurologic survival after out-of-hospital cardiac arrest. Ann Emerg Med 54:239-247.
79. Rydvall A, Bergenheim T, and Lynoe N. (2007). Decision making in a life-threatening cerebral condition: A comparative study of the ethical reasoning of intensive care unit physicians and neurosurgeons. Acta Anaesthesiol Scand 51:1338-1343. (Pubitemid 47609512)
80. Rydvall A and Lynoe N. (2008). Withholding and withdrawing life-sustaining treatment: A comparative study of the ethical reasoning of physicians and the general public. Crit Care 12:R13.
81. Samuel H. 2008. Mont Blanc avalanche - Dozens more could have died. Daily Telegraph. http://www.telegraph.co.uk/news/worldnews/europe/france/2619922/ Mont-Blanc-avalanche-Dozens-more-could-have-died.html
82. Sasson C, Hegg AJ, Macy M, Park A, Kellermann A, and McNally B. (2008). Pre-hospital termination of resuscitation in cases of refractory out-of-hospital cardiac arrest. JAMA 300:1432-1438.
83. Schlotzhauer AV and Liang BA. (2002). Definitions and implications of death. Hematol Oncol Clin North Am 16:1397-1413. (Pubitemid 36015012)
84. Skrifvars MB, Vayrynen T, Kuisma M, Castren M, Parr MJ, Silfverstople J, Svensson L, Jonsson L, and Herlitz J. (2010). Comparison of Helsinki and European Resuscitation Council ''do not attempt to resuscitate'' guidelines, and a termination of resuscitation clinical prediction rule for out-of-hospital cardiac arrest patients found in asystole or pulseless electrical activity. Resuscitation 81:679-684.
85. Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, Brugger H, Deakin CD, Dunning J, Georgiou M, Handley AJ, Lockey DJ, Paal P, Sandroni C, Thies KC, Zideman DA, and Nolan JP. (2010). European Resuscitation Council Guidelines for Resuscitation 2010: Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 81:1400-1433.
86. Strapazzon G, Beikircher W, Procter E, and Brugger H. (2012). Electrical heart activity recorded during prolonged avalanche burial. Circulation 125:646-647.
87. Stratton SJ and Rashi P. (2008). Out-of-hospital unwitnessed cardiopulmonary collapse and no-bystander CPR: A practical addition to resuscitation termination guidelines. J Emerg Med 35:175-179. (Pubitemid 352033676)
88. Sumann G, Paal P, Mair P, Ellerton J, Dahlberg T, Zen-Ruffinen G, Zafren K, and Brugger H. (2009). Fluid management in traumatic shock: A practical approach for mountain rescue. Official recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol 10:71-75.
89. Tipton MJ and Golden FS. (2011). A proposed decision-making guide for the search, rescue and resuscitation of submersion (head under) victims based on expert opinion. Resuscitation 82:819-824.
90. Tomazin I, Ellerton J, Reisten O, Soteras I, and Avbelj M. (2011). Medical standards for mountain rescue operations using helicopters: Official consensus recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol 12:335-341.
91. Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, Jeejeebhoy FM, and Gabrielli A. (2010). Part 12: Cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122:S829-861.
92. Verbeek PR, Vermeulen MJ, Ali FH, Messenger DW, Summers J, and Morrison LJ. (2002). Derivation of a termination-of-resuscitation guideline for emergency medical technicians using automated external defibrillators. Acad Emerg Med 9:671-678. (Pubitemid 34747253)
93. Walpoth BH, Walpoth-Aslan BN, Mattle HP, Radanov BP, Schroth G, Schaeffler L, Fischer AP, von Segesser L, and Althaus U. (1997). Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med 337:1500-1505. (Pubitemid 27495775)
94. WHO. 2002a. World Heath Organization. Drowning factsheet. In: World Heath Organization.
95. WHO. 2002b. World Heath Organization. Enemies of health, allies of poverty. Page 8. In: World Heath Organization.
96. Willis CD, Cameron PA, Bernard SA, and Fitzgerald M. (2006). Cardiopulmonary resuscitation after traumatic cardiac arrest is not always futile. Injury 37:448-454. (Pubitemid 46137877)
97. Youn CS, Choi SP, Yim HW, and Park KN. (2009). Out-of-hospital cardiac arrest due to drowning: An Utstein Style report of 10 years of experience from St. Mary's Hospital. Resuscitation 80:778-783.
98. Zafren K, Durrer B, Herry JP, and Brugger H. (2005). Lightning injuries: Prevention and on-site treatment in mountains and remote areas. Official guidelines of the International Commission for Mountain Emergency Medicine and the Medical Commission of the International Mountaineering and Climbing Federation (ICAR and UIAA MEDCOM). Resuscitation 65:369-372.