Outcome of Avalanche Victims with Out-of-Hospital Cardiac Arrest
Although prior studies have focused on avalanche victims with long durations of burial (>35 minutes), few studies have targeted avalanche victims with short duration of burial (<35 minutes). In the absence of severe trauma, asphyxia is thought to be one of the main causes of cardiac arrest after avalanche burial. As the use of avalanche transceivers has increased, bystanders are more likely to locate victims quickly and begin resuscitation. The purpose of this study was to evaluate prehospital and in-hospital resuscitation efforts and ultimate outcomes for avalanche victims with a short duration of burial suffering out-of-hospital cardiac arrest.
Investigators performed a retrospective observational study from 2008 to 2013 from an avalanche accident registry in the Austrian Tyrolean Alps. Data were collected for prehospital care, in-hospital care, patient mortality, and neurological outcomes. A total of 55 victims were included in this study: 32 victims (58%) were declared dead at the scene with no resuscitative efforts, all with either signs of severe trauma or prolonged burial time. Cardiopulmonary resuscitation (CPR) was performed on 23 victims (42%), with only 2 victims experiencing a witnessed cardiac arrest. Nine of the victims receiving CPR had a short duration of burial (<35 minutes). All of these 9 patients achieved return of spontaneous circulation (ROSC), 4 victims after bystander CPR and 5 victims after advanced emergency medicine care at the hospital. Five of the 9 victims survived to hospital discharge, but only 2 with full neurological recovery.
Although there was an overall 91% mortality for all patients included in the study with out-of-hospital arrest after an avalanche, the prognosis is slightly improved for victims with a short duration of burial and ROSC. Two of the 9 patients (22%) who were buried for less than 35 minutes and achieved ROSC had a full neurological recovery. This study highlights the poor prognosis of out-of-hospital cardiac arrest for avalanche victims, but also identifies potential education for bystander rescuers. In the absence of severe trauma, first-responders should focus on decreasing burial duration, providing adequate CPR, avoiding hypothermia, and expediting transfer to definitive care for avalanche victims.
(Resuscitation. 2015;89:114–118) L Moroder, B Mair, H Brugger, et al.
Prepared by Matthew Stewart, MD, FAWM, University of Utah Emergency Medicine Global Health Fellow, Salt Lake City, UT, USA.