Resuscitation of Avalanche Victims: Evidence-based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Intended for Physicians and Other Advanced Life Support Personnel
Avalanches are becoming more common and kill approximately 150 people in North America and Europe each year. There are several guidelines published regarding on-site management and transport of avalanche victims, most recently in 2010 from the International Liaison Committee on Resuscitation. The authors’ goal was to develop evidence-based guidelines for 27 key aspects of avalanche rescue and to obtain a consensus for the International Commission for Mountain Emergency Medicine. After an extensive literature search, 96 high-quality and relevant articles were chosen for full review.
Excluding lethal trauma and clearly nonsurvivable conditions, the investigators found that avalanche victim survival rate is 77% and is primarily determined by the grade of burial, duration of burial, asphyxia, core temperature, and trauma. Interestingly, hypothermia is rarely the primary cause of death if the victim’s airway is patent. Grade of burial was the strongest predictor of survival, with 47.6% survival rate for complete burials vs 95.8% for partial burials. Prior studies have shown the survival rates precipitously drop after approximately 10 to 18 minutes of burial. The authors proposed a 35-minute burial time to guide rescue efforts: for victims buried less than 35 minutes found in cardiac arrest, asphyxia should be assumed and cardiopulmonary resuscitation should be started. Advanced airway intervention should be considered if the rescuer is competent; however, inexperienced rescuers should continue mouth-to-mouth or bag-mask ventilation. Guidelines for termination of cardiopulmonary resuscitation include lethal injury, completely frozen, blocked airway, burial time more than 35 minutes, serum potassium greater than 12 mmol/L, or unacceptable risk to the rescuing team. After adhering to appropriate spinal precautions and insulating against further heat loss, patients who can potentially survive should be carefully transported in a horizontal position to a nearby hospital with proper capabilities. This is a partial list of the primary recommendations; please review the article in detail before changing practice patterns.
(Resuscitation. 2012 Nov 2 [Epub ahead of print]) H Brugger, B Durrer, F Elsensohn, et al.