Citation

Brugger H, Strapazzon G, Wallner B, Paal P. Resuscitation 2019; ePub(ePub): ePub.

Affiliation

Department of Anaesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University, Kajetanerplatz 1, 5020 Salzburg, Austria; International Commission for Mountain Emergency Medicine ICAR MEDCOM, Italy. Electronic address: peter.paal@icloud.com.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.resuscitation.2019.07.039

PMID

31518614

Abstract

A recently published single-centre study in Switzerland has reported a high level of adherence of physician-staffed helicopter emergency medical teams to the current guidelines for the out-of-hospital management of completely buried avalanche victims. Patient management regarding critical decisions was correct in 93% of identified cases. However, despite this exemplary work none of the 66 recorded avalanche victims presenting with cardiac arrest on scene survived. Thirty-one patients (47%) were declared dead on scene, 35 (53%) were admitted to the hospital and seven (11%) underwent extracorporeal life-support. The rescue bases and authors involved should be commended both for the meticulous out-of-hospital and in-hospital data collection and analysis, plus the exceptionally high compliance with treatment recommendations compared with an earlier study.2 In this multi-centre study we have shown a lower level of compliance in Austria (1996–2009), which included 170 recorded avalanche victims presenting with cardiac arrest and a higher percentage of long duration burials (67% vs. only 35%). Notably, cardiopulmonary resuscitation was often continued to hospital admission in avalanche victims with short burial and asphyxial cardiac arrest, but withheld or terminated at the scene in those with long burial and possible hypothermic cardiac arrest.

Recent studies referring to arrested avalanche victim mortality have shown that survival is lower than expected in the past, because most patients will suffocate or die from trauma before they will become cold enough (e.g. <28 °C) to survive a prolonged cardiac arrest. Whereas, avalanche victims with a short duration of burial and cardiac arrest seem to have higher chances of remaining neurologically intact after resuscitation.

During the observation period of Metrailler-Mermoud’s study, the initial recommendations for out-of-hospital management of avalanche victims were adapted twice, whereby the latest ERC recommendations, published in 2015, were not implemented during the observation period. In these current recommendations the cut-offs for duration of burial were changed from 35 to 60 min, core temperature from 32 °C to 30 °C and ...

Language: en