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Avalanche Resuscitation Guideline Says Cardiac Arrest...

PostPosted: Tue Nov 20, 2012 10:57 pm
by mroutdoorsman
This is great news for the wilderness/mountain medical community. It is about time some evidence based research has been done regarding cardiac arrest and avalanche victims to better dictate treatment and increase survival of cardiac arrest in avalanche victims. For those of us in the medical field this is a very interesting read and may be interesting to others as well. Hope you all enjoy reading it!

Avalanche Resuscitation Guideline Says Cardiac Arrest Survival Relatively High

By Will Boggs, MD

NEW YORK (Reuters Health) Nov 08 - The International Commission for Mountain Emergency Medicine (ICAR MEDCOM) has published the first evidence-based guideline for resuscitation of avalanche victims.

"The core message is that rescuers as well as paramedics and emergency physicians should be aware of the special circumstances in an avalanche accident," Dr. Hermann Brugger from ICAR, Bozen/Bolzano, Italy told Reuters Health. "They should consider that even patients in cardiac arrest do have a good chance of survival if they are found with a patent airway which may indicate that they were able to breathe during burial."

The Commission reviewed 96 articles in establishing the guideline. The review showed that the overall survival rate of avalanche involvements is 77% and depends on the grade and duration of burial and the pathological processes of asphyxia, trauma, and hypothermia. Grade of burial is the strongest single factor for survival.

Throughout the guidelines, the authors emphasize prompt location and extrication of buried victims.

"First of all, physicians should make sure that conditions at the site of the avalanche are safe (we lost too many rescuers' lives in the line of duty due to secondary avalanches)," Dr. Brugger said. "Secondly, the physician should try to gather some information about the circumstances of the accident, the number of missed persons and the time when the avalanche was released to assess the duration of burial. If the buried victims are localized, the extrication from the snow masses should be done as carefully as possible and great attention to the patency of the airway should be paid."

CPR should be initiated in virtually all unresponsive cases, and ventilation should be combined with chest compression.

"If the airway of a patient who was buried more than 35 minutes is free, the physician should not give up hope, even in the absence of vital signs," Dr. Brugger said. "Especially if the cardiac arrest occurs during the rescue procedure or transport, that has been frequently reported, they should be treated optimistically and transported under continuous cardiopulmonary resuscitation to a center for extracorporeal rewarming. The longest successful cardiopulmonary resuscitation of a hypothermic patient reported in literature was six and a half hours and the neurological outcome of those survivors is amazingly excellent."

When trauma is evident, the guidelines recommend adequate spinal stabilization throughout extrication, on-scene management, and transport.

Hypothermia is common in avalanche victims. The guidelines recommend resuscitation for cardiac arrest victims with core temperatures below 32 degrees Celsius and a patent or unknown airway but suggest withholding resuscitation for those in asystolic cardiac arrest, core temperature below 32 degrees Celsius, and an obstructed airway.

Rewarming and oxygen therapy are also advised for hypothermic victims.

Dr. Brugger and colleagues will be establishing an international registry for collecting data on out-of hospital and in-hospital avalanche victims. "We know very little about the pathophysiological factors determining survival and about the cooling rates during and after burial," he said. "So, monitoring the core temperature and analyzing clinical data would help us to better understand why some of the victims are able to survive while others do not."

The full guideline was published online November 1 in Resuscitation.

SOURCE: ... 3/abstract

Resuscitation 2012.

Re: Avalanche Resuscitation Guideline Says Cardiac Arrest...

PostPosted: Wed Nov 21, 2012 8:15 pm
by DukeJH
Interesting. I hadn't thought of hypothermia as a means to prolong the chance of resuscitation and full recovery. Thanks.

Re: Avalanche Resuscitation Guideline Says Cardiac Arrest...

PostPosted: Wed Nov 21, 2012 11:50 pm
by mroutdoorsman
DukeJH wrote:Interesting. I hadn't thought of hypothermia as a means to prolong the chance of resuscitation and full recovery. Thanks.

In the Emergency Department and in some pre-hospital (ambulance) systems induced hypothermia is an evidence based practice for cardiac arrest patients. This is done AFTER ROSC or Return of Spontaneous Circulation. ROSC normally occurs after successful CPR or other resuscitation methods. The induced hypothermia is kept in place until after the patient has been through a successful cardiac catheterization procedure, pharmaceutical methods or open heart surgery.

Re: Avalanche Resuscitation Guideline Says Cardiac Arrest...

PostPosted: Wed Nov 28, 2012 12:42 am
by philoparts
In regards to hypothermia (avalanche, cold water drowning) I was always trained under the mantra of "They're not dead until they're warm and dead".