A 65 year old man was brought into the resuscitation room in cardiac arrest. Forty five minutes earlier he had become short of breath before collapsing. The only other history available was that he had undergone a left pneumonectomy several years previously for carcinoma of the lung but was thought to have made a full recovery. Basic life support was performed by the patient's work colleagues and when the paramedics arrived the patient was asystolic. He was treated according to Advanced Life Support (ALS) guidelines¹ and briefly regained a cardiac output before he arrested again, this time in electro-mechanical dissociation (EMD). A total of 8 mg of adrenaline (epinephrine) was given by the paramedics. On arrival at the accident and emergency department the patient was intubated and cannulated. The …