Comparative Effectiveness of an Artificial Air Pocket Device to Delay Asphyxiation in Supine Individuals Critically Buried in Avalanche Debris

Abstract

ImportanceApproximately 70% of individuals critically buried in avalanche debris die within 35 minutes as a result of asphyxial cardiac arrest. An artificial air-pocket device (AAPD) that separates inhaled air from exhaled air may delay the onset of severe hypoxemia and eventual asphyxia during snow burial.ObjectiveTo investigate the efficacy of a new AAPD during snow burial in a supine position.Design, Setting, and ParticipantsThis comparative effectiveness trial was performed in winter 2016 with data analysis in November 2016 and November 2022. Each trial used a simulated critical avalanche burial scenario, in which a trough was dug in a snow pile and an additional air pocket of 0.5 L volume was punched into the lateral wall for each control trial. All participants were buried in a supine position. Trials could be voluntarily terminated at any time, with a maximum length of 60 minutes; trials were automatically terminated if the participant’s peripheral oxygen saturation (Spo2) dropped to less than 84%.ExposuresEach participant conducted 2 trials, one in which they breathed into the AAPD (intervention trial) and the other in which they breathed into the prepared air pocket (control trial).Main Outcomes and MeasuresMeasurements included Spo2, cerebral oxygenation, ventilatory parameters, respiratory gas concentrations, and visual-analogue scales. Kaplan-Meier survival curves and rank test for matched survival data were used to analyze the total burial time in each trial.ResultsA total of 13 volunteers (9 men; mean [SD] age, 33 [8] years) were exposed to the intervention and control trials. Intervention trials were terminated less often (2 of 13 trials) as a result of hypoxemia than control trials (11 of 12 trials). Similarly, survival curves showed a longer duration of burial in the intervention compared with the control trials for the time to reach an Spo2 less than 84% (rank test for matched survival data: P = .003). The intervention trials, compared with the control trials, also had slower rates of decrease in fraction of inspired oxygen (mean [SD] rate, −0.8 [0.4] %/min vs −2.2 [1.2] %/min) and of increase in fraction of inspired carbon dioxide (mean [SD] rate, 0.5 [0.3] %/min vs 1.4 [0.6] %/min) and expired ventilation per minute (mean [SD] rate, 0.5 [1.0] L/min2 vs 3.9 [2.6] L/min2).Conclusions and RelevanceThis comparative effectiveness trial found that the new AAPD was associated with delaying the development of hypoxemia and hypercapnia in supine participants in a critical burial scenario. Use of the AAPD may allow a longer burial time before asphyxial cardiac arrest, which might allow longer times for successful rescue by companions or by prehospital emergency medical services.

Prevalence of airway patency and air pocket in critically buried avalanche victims - a scoping review

“…Though avalanche airbags and other preventive strategies have shown to be efficient in increasing survival probability in avalanche victims [ 5 , 43 , 44 ], the risk of critical burial persists [ 45 , 46 ]. Artificial air-pocket devices (AAPD) are intended to enable critically buried victims to delay asphyxia by channelling exhaled carbon dioxide away from the airways and may also offer airway protection by using a mouthpiece [ 10 , 11 ]. The usage and overall effectiveness of artificial air-pocket devices is still in question [ 46 , 47 ], mostly due to the concern on the capability to insert the mouthpiece during the cause of avalanche burial.…”

“…Personal preventive and protective avalanche equipment aims to reduce mortality among critically buried avalanche victims, avoiding asphyxia by channelling exhaled carbon dioxide away from the airway and providing fresh air from the surrounding snow to the critically buried victim [ 5 , 10 – 12 ]. Hence, the knowledge of prevalence of airway patency and the presence of an air pocket is of major interest for the triage and treatment of critically buried avalanche victims and gains paramount importance when assessing and comparing the overall effectiveness of these devices in its purpose of increasing survival.…”