Outcome of avalanche victims with out-of-hospital cardiac arrest |
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| Institution: | 1. Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria;2. Christophorus Emergency Medical Helicopter Service, Schubertring 1-3, 1010 Vienna, Austria;3. Institute of Mountain Emergency Medicine, EURAC Research, Viale Druso 1, 39100 Bolzano, Italy;4. Department of Anesthesiology and Critical Care Medicine, AUVA Trauma Hospital Salzburg, Dr.-Franz-Rehrl-Platz 4, 5010 Salzburg, Austria;2. Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan;1. Kantonsspital St. Gallen, Institut für Anästhesiologie, St. Gallen, Switzerland;2. Hochtaunus-Kliniken gGmbH, Krankenhaus Bad Homburg, Abteilung für Anästhesie und Operative Intensivmedizin, Bad Homburg, Germany;3. Schwarzwald-Baar-Klinikum, Villingen-Schwennigen Klinik für Neurochirurgie, Villingen-Schwenningen, Germany;4. Air Zermatt Basis, Raron, Switzerland;1. EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, 39100 Bolzano, Italy;2. Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria;3. WSL Institute for Snow and Avalanche Research SLF, Flüelastrasse 11, 7260 Davos, Switzerland;4. Austrian Board of Alpine Safety, Olympiastrasse 10, 6020 Innsbruck, Austria;5. Inova Q Inc. , Tinkhauserstrasse 5b, 39031 Brunico, Italy;1. Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark;2. Danish Armed Forces, Health Services, Aarhus, Denmark;3. Department of Thoracic Surgery, Aalborg University Hospital, Denmark;4. Department of Anaesthesia and Trauma Centre, Centre for Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Denmark;5. Department of Cardiology, Odense University Hospital, Denmark;6. Department of Cardio-Thoracic Anaesthesiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark;1. Nordland Hospital Lofoten, Lofoten Islands, Norway;2. East Anglian Air Ambulance, Cambridge, UK;3. Colorado Avalanche Information Center, Boulder, CO;4. Haukeland University Hospital, Bergen, Norway |
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| Abstract: | Study backgroundPrevious studies focused on the outcome of avalanche victims with out-of-hospital cardiac arrest (OHCA) after long duration of burial (>35 min); the outcome of victims with short duration (≤35 min) remains obscure.Aim of the studyTo investigate outcome of avalanche victims with OHCA.MethodsRetrospective analysis of avalanche victims with OHCA between 2008 and 2013 in the Tyrolean Alps.Results55 avalanche victims were identified, 32 of whom were declared dead after extrication without cardiopulmonary resuscitation (CPR), all with long duration of burial. In the remaining 23 CPR was initiated at scene; three were partially and 20 completely buried, nine of whom suffered short and 11 long duration of burial. All nine victims with short duration of burial underwent restoration of spontaneous circulation (ROSC) at scene, four of them after bystander CPR, five after advanced life support by the emergency physician. Two patients with ROSC after short duration of burial and bystander CPR survived to hospital discharge with cerebral performance category 1. None of the 11 victims with long duration of burial survived to hospital discharge, although six were transported to hospital with ongoing CPR and three were supported with extracorporeal circulation.ConclusionsIn this case series survival with favourable neurological outcome was observed in avalanche victims with short duration of burial only if bystander CPR was immediately performed and ROSC achieved. Strategies for reducing avalanche mortality should focus on prompt extrication from the snow and immediate bystander CPR by uninjured companions. |
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| Keywords: | Cardiopulmonary resuscitation Avalanche Asphyxia Outcome Bystander |
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