Doctors battled for 40 minutes to save James Gandolfini after he suffered a heart attack in his hotel room in Italy on Wednesday night, doctors have revealed.
Medical staff rushed to Hotel Boscolo in Rome after the actor's 13-year-old son found his father suffering the attack in their bathroom around 10pm on Wednesday.
He was taken by ambulance to Policlinico Umberto I hospital where he was pronounced dead. The actor, best known for his role as Tony Soprano in HBO series The Sopranos, was just 51.
'The resuscitation maneuvers, including heart massage etc., continued for 40 minutes and then, seeing no electric activity from the heart, this was interrupted and we declared James dead,' said emergency room chief Claudio Modini.
'Final pictures': A holidaymaker took this photograph of James Gandolfini enjoying dinner in Rome on Tuesday night - around 24 hours before he passed away suddenly following a suspected heart attack
'Final pictures': A holidaymaker took this photograph of James Gandolfini enjoying dinner in Rome on Tuesday night - around 24 hours before he passed away suddenly following a suspected heart attack

At ease: Witnesses said Gandolfini appeared to be enjoying dinner and the 'magical atmosphere'
At ease: Witnesses said Gandolfini appeared to be enjoying dinner and the 'magical atmosphere'
'The patient was considered dead on arrival, and for that reason an autopsy has been requested to be carried out by a pathologist, as is normal procedure in our country.'
The autopsy is expected to be carried out today.
Details about Gandolfini's final moments come as a photograph has emerged apparently showing Gandoflini enjoying an evening out with his family the night before his sudden death
In what could be the last picture of the award-winning actor, Gandolfini appeared at ease and in good health as he ate dinner at the Sabatini Restaurant with his son Michael, according to fellow holidaymaker Blake Kahn, who took the photo.
 

Another member of Kahn's group, Dee Duncan of Roswell, Georgia added that Gandolfini looked as if he was enjoying the 'magical atmosphere' as jugglers and magicians performed in the square.
Kahn, from Atlanta, Georgia, later shared the images with 11Alive.
The Sopranos star was on vacation in Rome with Michael, wife Deborah and their nine-month-old daughter Liliana to 'reconnect with his Italian roots' before the Taormina Film Festival in Sicily.
His Sopranos colleagues have led tributes from the showbiz world, with the show's creator David Chase who compared him to Mozart, praising him as 'one of the greatest actors of this or any time'.
Witness: James Gandolfini was found suffering a heart attack in a hotel bathroom by his 13-year-old son Michael. They are pictured with his second wife Deborah Lin at a film premiere in 2011
Witness: James Gandolfini was found suffering a heart attack in a hotel bathroom by his 13-year-old son Michael. They are pictured with his second wife Deborah Lin at a film premiere in 2011

Tests: The mortuary of Umberto hospital where Gandolfini was pronounced dead on Wednesday. His body will undergo an autopsy on Thursday, as is required by Italian law
Tests: The mortuary of Umberto hospital where Gandolfini was pronounced dead on Wednesday night. His body will undergo an autopsy on Thursday, as is required by Italian law
Mario Sesti, director of the film festival which the star was due to attend this weekend, claimed that Gandolfini was excited by his Italian vacation because of his family's link to the country.
'He was so happy to be in Italy, to reconnect with his Italian roots, and he was very excited to come here and receive this award,' he told USA Today.
Gandolfini was born and brought up in New Jersey, but both his parents were Italian.
The Taormini Film Festival will host a tribute to the actor in place of a round-table discussion which Gandolfini had agreed to take part in.
The actor and his family had spent a 'beautiful day out together' in Rome before his tragic passing, according to Gandolfini's assistant, Tom Richardson.
In a sign that he was generous until the end, a holidaymaker claimed on Facebook that Gandolfini, who was staying at the same hotel, witnessed a boy stealing a few Euros from her and 'ran after me in to the elevator to make sure that I was ok.' 'Good man,' she added.

Married to the mob: In character with his Sopranos co-stars Edie Falco, Robert Iler and Jamie-Lynn Sigler
Married to the mob: In character with his Sopranos co-stars Edie Falco, Robert Iler and Jamie-Lynn Sigler
According to Mike Sullivan, a close friend of Gandolfini's, Richardson told him: 'When they got back to the hotel, Jimmy went to use the restroom. And something happened in there. 
'His sister said he was alive when they took him out in the ambulance on the way to the hospital.'
When paramedics arrived to take Gandolfini to hospital, they found him lying on the bathroom floor, according to hotel owner Antonio D'amore.
The actor was taken to hospital at 10.20pm, and was pronounced dead at 11pm when efforts to revive him were unsuccessful, according to Dr Modini.
Gandolfini's first wife Marcy Wudarski, Michael's mother, is said to have immediately booked a flight to Italy to comfort her son after learning of the actor's death.
The couple were married for three years until they divorced in 2002.
Divorce papers from 2002 show Wudarski accused him of battling serious issues with drugs and alcohol which saw him 'punch himself in the face with frustration'.
Hotel: Gandolfini had a heart attack in his bathroom at the Hotel Boscolo, pictured, in Rome
Hotel: Gandolfini had a heart attack in his bathroom at the Hotel Boscolo, pictured, in Rome
Emergency services: An ambulance parked in the square outside the hotel today
Emergency services: An ambulance parked in the square outside the hotel today
The scene: People walk in the entrance of the morgue of Policlinico Umberto I hospital where the body of actor Gandolfini was brought after he was reported dead late Wednesday
The scene: People walk in the entrance of the morgue of Policlinico Umberto I hospital where the body of actor Gandolfini was brought after he was reported dead late Wednesday
At the hospital: Members of the media gather outside the emergency department of Policlinico Umberto I
At the hospital: Members of the media gather outside the emergency department of Policlinico Umberto I
According to GQ, those who worked with the actor on the HBO drama from 1999 to 2007 saw him frequently 'berate himself in disgust, curse and smack the back of his own head'.
Wudarski also alleged that he dated a string of women, including a stripper.
In response, Gandolfini claimed that his wife constantly threatened to kill herself and blamed her emotional instability and volatile temper for the marriage breakdown.
He filed for divorce on the grounds of cruel and inhuman treatment. At the time his wife said his departure had come as a shock.

Gandolfini's second wife, former model Deborah Lin, was with the star in Italy along with their daughter Liliana.
The pair married in Hawaii in 2008, and Liliana was born last October. After his daughter's birth, Gandolfini said he was 'thrilled' to become a father for the second time.

Grief: Family spokesman Michael Kobold giving a statement on Gandolfini's death
Grief: Family spokesman Michael Kobold giving a statement on Gandolfini's death

Tributes: Fans leaves flower and gifts outside of Gandolfini's New York City apartment on Thursday
Tributes: Fans leaves flower and gifts outside of Gandolfini's New York City apartment on Thursday
The actor rose to fame playing a hitman in the 1993 film True Romance, and roles in films such as Terminal Velocity and Get Shorty followed.

However, it was not until his breakout role in 1999 in the hit television show The Sopranos that he  became a household name.
He played the powerful mob boss Tony Soprano, whose stressful gangster and family life left him needing to visit a psychiatrist, played by Lorraine Bracco.
His compelling portrayal of the ruthless mob boss who suffered from panic attacks saw him win three Emmy Awards for the role.

The character apparently died in the series finale, although the audience was never shown the moment of his death, with the screen just fading to black instead.

Speaking to Vanity Fair about the ending, Gandolfini said: ‘What the f***? I mean, after all I went through, all this death, and then it’s over like that?'
Gandolfini's managers Mark Armstrong and Nancy Sanders paid tribute to the star, saying in a statement: 'Our hearts are shattered and we will miss him deeply. He and his family were part of our family for many years and we are all grieving.'
James Gandolfini
Breakout role: Gandolfini is best known for his role as Tony Soprano in hit HBO series The Sopranos
Tony Soprano and Lorraine Bracco, as Dr. Jennifer Melfi, from a scene from the fourth season of The Sopranos HBO
Compelling: Gandolfini (Tony Soprano) and Lorraine Bracco, as Dr. Jennifer Melfi, in a scene from the fourth season of The Sopranos
Tribute: Sopranos creator David Chase, pictured with Gandolfini, compared the actor with Mozart
Tribute: Sopranos creator David Chase, pictured with Gandolfini, compared the actor with Mozart
First big role: Gandolfini in 1993's True Romance, in which he also played a mobster
First big role: Gandolfini in 1993's True Romance, in which he also played a mobster
Cable channel HBO, which hosted The Sopranos until the show ended in 2007, called the actor a 'special man, a great talent, but more importantly a gentle and loving person who treated everyone, no matter their title or position, with equal respect.'
'We're all in shock and feeling immeasurable sadness at the loss of a beloved member of our family,' HBO added.
'He touched so many of us over the years with his humor, his warmth and his humility. Our hearts go out to his wife and children during this terrible time. He will be deeply missed by all of us.'
The Sopranos creator David Chase called his leading actor 'a genius'.
He said: 'Anyone who saw him even in the smallest of his performances knows that. He is one of the greatest actors of this or any time. A great deal of that genius resided in those sad eyes.
'I remember telling him many times, "You don't get it.  You're like Mozart." There would be silence at the other end of the phone.'
James Gandolfini
Devoted dad: James was said be 'thrilled' at the arrival of his daughter last year; he is pictured carrying her to lunch with his wife in May
Actor James Gandolfini and his first wife Marcy in 2001
 James Gandolfini and Deborah Lin 'Cinema Verite' HBO film premiere, Los Angeles, America - 11 Apr 2011
Family tragedy: The actor was married twice, to Deborah Lin, left, mother of his nine month old daughter, and right, Marcy Wudarski the mother of son Michael who has flown to Rome to be with him
James Gandolfini marries Deborah Lin. The couple tied the knot on the islands of Hawaii over the Labor Day weekend in 2008
James Gandolfini marries Deborah Lin. The couple tied the knot on the islands of Hawaii over the Labor Day weekend in 2008
Mr Chase added: 'He wasn't easy sometimes. But he was my partner, he was my brother in ways I can't explain and never will be able to explain.'

Chris Albrecht, who commissioned the crime drama for HBO and approved Gandolfini for the role, told Deadline: 'Absolutely stunned. I got the word from Lorraine Bracco and just got off with Brad Grey who had just heard from David Chase.

'We had all become a family. This is a tremendous loss.'
And Steve Schrirripa, who played Bobby Baccalieri in the show, said upon hearing the news: 'I had to get up and leave. It was like being told a brother had died. Jimmy Gandolfini was as great a friend as he was an actor and a human being.
'The phone hasn’t stopped. I spoke to a lot of the guys from The Sopranos. We were crying. People joke about us being a family. But we are a family.'
The Sopranos
Complex character: James Gandolfini alongside actors Tony Sirico Federico Castellucio, and Steven Van Zandt in The Sopranos
Gandolfini was the head of a mob family in show Sopranos
The mob boss: Gandolfini was the head of a mob family in show Sopranos
The Sopranos
Celebrated: James and his on-screen wife Edie Falco both won at the 2000 Golden Globes for their roles as Tony and Carmela Soprano
His co-star Joseph Gannascoli, who plays Vito Spatafore in the show, told MailOnline that Gandolfini was a 'tremendous person'.
An emotional Gannascoli said: 'He came to my wedding with his son and spoke beautiful words in front of everyone to me and my wife.'
He said that the greatest tragedy was that Gandolfini's son and daughter would grow up without their father. The actor said that Gandolfini was a generous guy with no airs about him who made everyone feel comfortable.
He told of a time that Gandolfini had been scheduled to make an appearance at his Brooklyn restaurant and despite being ill and it pouring with rain, he took pictures with everyone in a line of people who had queued around the block.
Gandolfini's sudden and unexpected death has prompted a huge outpouring of grief from those who worked with the actor, with many celebrities taking to Twitter to pay tribute.

Actor and friend Gilles Marini revealed on his Facebook page that Gandolfini had travelled to Italy with his son Michael for a 'boy trip'.
Tribute: Gandolfini's picture is displayed in the window of a restaurant in the Little Italy neighborhood of New York following his sudden death
Tribute: Gandolfini's picture is displayed in the window of a restaurant in the Little Italy neighborhood of New York following his sudden death on Wednesday

James Gandolfini
Versatile: James Gandolfini starred opposite Twilight's Kristen Stewart in the heartwarming 2010 movie Welcome To The Rileys
'I am heartbroken. My bud James Gandolfini just died. Last Saturday he told me at our kids graduation [that] he was so happy to go with his son to Italy. A boy trip!' Marini wrote.
He added: 'It was an honor to have met this man, such a great Dad! I spent so much time with James son teaching him soccer. I feel for that kid it must be so hard right now for little [Michael].'
'RIP James Gandolfini. A great friend,' wrote Jeff Daniels, his co-star in Broadway's God of Carnage. 
'I am so deeply saddened by the untimely passing of sweet James Gandolfini!', tweeted Christina Applegate, his co-star in the 2004 comedy Surviving Christmas. 'My heart is broken for his family!! I’m in shock.'
Steve Carell, who was about to work with the larger-than-life star in HBO Films' Bone Wars, added: 'James Gandolfini. Unbelievably sad news. A fine man.'
In his younger days: As a basketball star at Ridge High School, Park Ridge in New Jersey
In his younger days: As a basketball star at Ridge High School, Park Ridge in New Jersey
Following the success of the HBO television series - which finished in 2007 - he continued to make big screen appearances in critically acclaimed films including In The Loop and The Taking of Pelham 123.
James Gandolfini
Senior year: James Gandolfini, in 1979 at Park Ridge High School, New Jersey

He appeared alongside Twilight actress Kristen Stewart in the heartwarming drama Welcome to the Rileys and voiced the 'Wild Thing' Carol in Where the Wild Things Are.
He recently played Secretary of Defense Leon Panetta in the Oscar nominated film Zero Dark Thirty.
In his personal life, Gandolfini made his first public appearance with Deborah at the premiere of the second half of the sixth and final series of The Sopranos in March 2007.
At their wedding a year later, they exchanged vows in front of family and friends at Honolulu's Central Union Church.
Deborah wore a white gown made of Italian lace, while the church was decorated with white lilies and rhododendrons.
Born in Westwood, New Jersey, Gandolfini graduated from Park Ridge High School, where he cut his teeth acting in school plays, and went on to study communications at Rutgers University.
New Jersey Governor Chris Christie has described himself as a 'huge fan' of Gandolfini.
'It's an awful shock. James Gandolfini was a fine actor, a Rutgers alum and a true Jersey guy,' he said.
In his school days: Gandolfini poses with a female friend in a picture from his High School year book in 1979; he was voted 'class flirt'
In his school days: Gandolfini poses with a female friend in a picture from his High School year book in 1979; he was voted 'class flirt'
Gandolfini started his professional acting career treading the boards in New York, and made his Broadway debut in the 1992 revival of A Streetcar Named Desire with Jessica Lange and Alec Baldwin.
Although his first film role came before in the 1987 comedy horror movie Shock! Shock! Shock! and also had a minor role in the Melanie Griffith thriller A Stranger Among Us. 
Gandolfini had a number of projects completed before his death including Violet & Daisy starring Saoirse Ronan, and another project by director Nicole Holofcener starring Catherine Keener.
In an interview in December last year, Gandolfini sounded upbeat about a slew of smaller roles following the breathtaking blackout ending in 2007 of The Sopranos.
'I'm much more comfortable doing smaller things,' Gandolfini said.
'I like them. I like the way they're shot; they're shot quickly. It's all about the scripts - that's what it is - and I'm getting some interesting little scripts.'

LOVING TRIBUTES: CELEBRITIES EXPRESS THEIR GRIEF ON TWITTER

Gandolfini
Broadway: James with actor Jeff Daniels
'RIP James Gandolfini. A great friend,' wrote Jeff Daniels, his co-star in Broadway's God of Carnage.
'I am so deeply saddened by the untimely passing of sweet James Gandolfini!' tweeted Christina Applegate, his co-star in the 2004 comedy Surviving Christmas. 'My heart is broken for his family!! I’m in shock.'
Steve Carell, who was about to work with the larger-than-life star in HBO Films' Bone Wars, tweeted: 'James Gandolfini. Unbelievably sad news. A fine man.'
Olivia Wilde, who starred with the actor in The Incredible Burt Wonderstone, said: 'James Gandolfini was a kind, funny, wonderful guy. I'm so lucky to have worked with him. Sending love to his family. Such a sad, sad day.'
Patrick Wilson wrote: 'R.I.P. James Gandolfini. So awful. What a fantastic actor…so much to say but I can’t even process. My condolences to his family.'
Bush rocker Gavin Rossdale said: 'james gandolfini– so sad what an incredible actor. more loss. be good to each other. it’s all so short.'
Actor Jonah Hill: 'I'm truly heartbroken to hear that James Gandolfini has passed away. He is one of my all time favorite actors. Tragic loss.'
Rose McGowan
Touching tribute: Actress Rose McGowan posted this picture of herself and James on Twitter
Rose McGowan posted a picture of herself with the actor, saying: 'I am heartbroken about James Gandolfini. He was a gentle giant and great man. I love this picture, I loved him.'
Carson Daly: 'SO SAD! PRAYING FOR HIS FAMILY- wow- Shocked by this news today….'
Josh Henderson: 'Just read about James Gandolfini.. Never met him but what a damn good actor. Gone way to soon. Rip brother.. #prayers'
Dominic Monaghan: 'Oh man James gandolfini died. Fantastic in the soprano, and true romance. A great talent.'
Alyssa Milano: 'Rest in peace, Mr. Gandolfini.'
Rainn Wilson: 'Arrivederci, James Gandolfini. You were one of the great greats. We’ll miss your dangerous, big heart. #RIPGandolfini'
Josh Groban: 'Thank you James Gandolfini for some of the most brilliant tv moments of all time. So sad!!!'
Giuliana Rancic: 'Just heard James Gandolfini has died of a heart attack at the age of 51. So incredibly sad.'
Leah Remini: 'R.I.P James Gandolfini. My prayers to his family and friends. He will certainly be missed by us who loved watching him'