A 27 year old woman suffered a witnessed cardiac arrest in rural Iceland and regained pulse after one hour's resuscitation. She was trans­ported by an air ambulance to a tertiary medical center in Reykjavik where she was diagnosed with a large pulmonary embolus. After 24 hours therapeutic hypothermia she was rewarmed and extubated two days later. She was discharged from the hospital after two weeks  neurologically intact. This case illustrates that even in rural circumstances the chain of survival works if all the links are strong, with early access, early resuscitation and early advanced care.

Sigmundsson TS, Arnason B, Kristjansdottir TE, Vernhardsson V

¹Department of Anaesthesia and Critical Care, Karolinska University Hospital, Solna ² Department of Anaesthesia and Critical Care, The National University Hospital of Iceland ³Intern­- ship at the Health Central of Eastern Iceland and the National University Hospital of Iceland ⁴Volunteer Rescuer and Resident at Möðrudalur ⁵Department of Air Ambulance Services, Akureyri Teaching Hospital