Application form
TTM2 S1Country:
TTM2 S2Name of hospital:
TTM2 S3Street Address:
TTM2 S4Zip code:
TTM2 S5City:
TTM2 S6Telephone:
TTM2 S7Email:
TTM2 S8Name of site investigator:
TTM2 S9Additional contact or co-investigator?
TTM2 S10Email
TTM2 S11Population served (approx):
TTM2 S12Type of intensive care unit?
TTM2 S13Number of ventilator beds:
TTM2 S14Number of OHCA-patients/year
TTM2 S15Estimated no. of patients fulfilling TTM2 inclusion criteria / year
TTM2 S16Participation endorsed by head of department?
TTM2 S17Is there an intensive care specialist 24h a day in your ICU?
TTM2 S18Please specify staffing?
TTM2 S19Do you have a standardised protocol for cardiac arrest patients?
TTM2 S20Do you have a standardised follow-up plan for cardiac arrest patients?
TTM2 S21Possibility to perform angiography/PCI 24 h a day, seven days a week
TTM2 S22Will it be possible to refer all patients eligible for acute coronary angiography to another TTM2-trial site?
TTM2 S23Blood gas management?
TTM2 S24If both alpha-stat and pH-stat, please specify reason?
TTM2 S25EEG available?
TTM2 S26SSEP available?
TTM2 S27Does your unit have a study nurse who is able to participate in the TTM2-trial?