Survival after avalanche-induced cardiac arrest

Does Rescue Collapse Mandate a Paradigm Shift in the Field Management of Avalanche Victims?

“…These results are in agreement with another recent publication, which highlighted the more favorable outcome of the subgroup of hypothermic victims who sustained a witnessed arrest (i.e., ''rescue collapse'') (Boué et al, 2014a). Two case reports also supported the excellent survival and neurological outcome of rescue collapse victims (Boué et al, 2014b).…”

“…Two case reports also supported the excellent survival and neurological outcome of rescue collapse victims (Boué et al, 2014b). Rescue collapse is defined as ''the occurrence of cardiac arrest related to the patient's extrication or transfer in profound hypothermia'' (Boué et al, 2014a), and was mentioned in the CISA-IKAR guidelines on resuscitation of avalanche victims in 2013 (Brugger et al, 2013).…”

“…After reviewing these recent publications (Boué et al, 2014a;2014b;Mair et al, 2014), we changed our practical field approach: in an unconscious avalanche victim fully buried for more than 35 minutes and found with a patent airway, cardiac monitoring with multifunction defibrillator electrodes is applied as soon as the torso is exposed; then vital signs are sought for 1 minute, paying particular attention to respiration. This pragmatic approach was presented and tested during our annual pre-winter season field training in December 2014, and will now be applied in the field.…”

Outcome of avalanche victims with out-of-hospital cardiac arrest

“…17 Another French study reported an overall survival rate of 16.7% in OHCA avalanche victims presenting with moderate or severe hypothermia, whereby only 6.3% showed favourable neurological outcome after 3 months. 18 The number of arrested avalanche victims after long duration of burial benefitting from extracorporeal support is obviously small and the potential of extracorporeal support to improve survival in avalanche victims may be less than expected. One reason to withhold or terminate CPR is major trauma considered not compatible with survival.…”

Outcome after severe accidental hypothermia in the French Alps: A 10-year review

“…In the highly specific situation of an avalanche, the hypoxic (or traumatic) origin of the cardiac arrest is highly suspected if the core temperature is over 32 • C or if burial time under the snow is less than 35 min. 12 In such conditions, hypothermia is unlikely the cause of the cardiac arrest and an ECLS rewarming strategy is not indicated. 1,10,31 Apart from these specific clinical conditions, there is a lack of objective data helping rescue teams make "reasonable decisions" to avoid ECLS that is futile and exhausting for the rescue teams.…”