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Avalanche resuscitation

Øyvind Sverre Svendsen, Ketil Grong, Knut Sverre Andersen, Paul Husby
BACKGROUND: Accidental hypothermia with arrested circulation remains a condition associated with high mortality. In our institution, extracorporeal circulation (ECC) rewarming has been the cornerstone in treating such patients since 1987. We here explore characteristics and outcomes of this treatment, to identify significant merits and challenges from 3 decades of experience in ECC rewarming. METHODS: Sixty-nine patients rewarmed by ECC during the period from December 1987 to December 2015 were analyzed...
September 27, 2016: Annals of Thoracic Surgery
Giacomo Strapazzon, Judith Plankensteiner, Peter Mair, Elfriede Ruttmann, Tomas Dal Cappello, Emily Procter, Hermann Brugger
AIM: The aim of this study is to describe the prehospital management and outcome of avalanche patients with out-of-hospital cardiac arrest in Tyrol, Austria, for the first time since the introduction of international guidelines in 1996. PATIENTS AND METHODS: This study involved a retrospective analysis of all avalanche accidents involving out-of-hospital cardiac arrest between 1996 and 2009 in Tyrol, Austria. RESULTS: A total of 170 completely buried avalanche patients were included...
March 17, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Sven Christjar Skaiaa, Øyvind Thomassen
Avalanches may be provoked spontaneously or as a result of human activity, and they trigger the need for considerable rescue resources. Avalanche search and rescue operations are complex and characterised by physical and mental stress. The guidelines for resuscitation of avalanche victims may be perceived as complex and abstruse, which can lead to suboptimal treatment and an increased strain on rescue teams. The purpose of this article is to summarise the principles for medical treatment of avalanche victims...
March 15, 2016: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
Guillaume Debaty, Ibrahim Moustapha, Pierre Bouzat, Maxime Maignan, Marc Blancher, Amandine Rallo, Julien Brun, Olivier Chavanon, Vincent Danel, Françoise Carpentier, Jean-François Payen, Raphaël Briot
OBJECTIVE: To describe the factors associated with outcome after accidental deep hypothermia. METHODS: We conducted a retrospective cohort study on patients with accidental hypothermia (core temperature <28 °C) admitted to a Level I emergency room over a 10-year period. RESULTS: Forty-eight patients were included with a median temperature of 26 °C (range, 16.3-28 °C) on admission. The etiology of hypothermia was exposure to a cold environment (n = 27), avalanche (n = 13) or immersion in cold water (n = 8)...
August 2015: Resuscitation
Luca Moroder, Birgit Mair, Hermann Brugger, Wolfgang Voelckel, Peter Mair
STUDY BACKGROUND: Previous studies focused on the outcome of avalanche victims with out-of-hospital cardiac arrest (OHCA) after long duration of burial (>35min); the outcome of victims with short duration (≤35min) remains obscure. AIM OF THE STUDY: To investigate outcome of avalanche victims with OHCA. METHODS: Retrospective analysis of avalanche victims with OHCA between 2008 and 2013 in the Tyrolean Alps. RESULTS: 55 avalanche victims were identified, 32 of whom were declared dead after extrication without cardiopulmonary resuscitation (CPR), all with long duration of burial...
April 2015: Resuscitation
Peter Mair, Hermann Brugger, Birgit Mair, Luca Moroder, Elfriede Ruttmann
International guidelines recommend using extracorporeal rewarming in all hypothermic avalanche victims with prolonged cardiac arrest if they have patent airways and a plasma potassium level≤12 mmol/L. The aim of this study was to evaluate outcome data to determine if available experience with extracorporeal rewarming of avalanche victims supports this recommendation. At Innsbruck Medical University Hospital, 28 patients with hypothermic cardiac arrest following an avalanche accident were resuscitated using extracorporeal circulation...
December 2014: High Altitude Medicine & Biology
B Champigneulle, F Bellenfant-Zegdi, A Follin, C Lebard, A Guinvarch, F Thomas, R Pirracchio, D Journois
AIM: Neuroprotective effects of hypothermia may explain surprisingly high survival rates reported after drowning in cold water despite prolonged submersion. We described a cohort of refractory hypothermic cardiac arrests (CA) due to drowning treated by extracorporeal life support (ECLS) and aimed to identify criteria associated with 24-h survival. METHODS: Eleven-year period (2002-2012) retrospective study in the surgical intensive care unit (ICU) of a tertiary hospital (European Hospital Georges Pompidou, Paris, France)...
March 2015: Resuscitation
Yvonnick Boué, Jean-François Payen, Julien Brun, Sébastien Thomas, Albrice Levrat, Marc Blancher, Guillaume Debaty, Pierre Bouzat
AIM: Criteria to prolong resuscitation after cardiac arrest (CA) induced by complete avalanche burial are critical since profound hypothermia could be involved. We sought parameters associated with survival in a cohort of victims of complete avalanche burial. METHODS: Retrospective observational study of patients suffering CA on-scene after avalanche burial in the Northern French Alps between 1994 and 2013. Criteria associated with survival at discharge from the intensive care unit (ICU) were collected on scene and upon admission to Level-1 trauma center...
September 2014: Resuscitation
Urs Pietsch, Volker Lischke, Christine Pietsch, Karl-Heinz Kopp
Mountain rescue operations often present helicopter emergency medical service crews with unique challenges. One of the most challenging problems is the prehospital care of cardiac arrest patients during evacuation and transport. In this paper we outline a case in which we successfully performed a cardiopulmonary resuscitation of an avalanche victim. A mechanical chest-compression device proved to be a good way of minimizing hands-off time and providing high-quality chest compressions while the patient was evacuated from the site of the accident...
June 2014: Wilderness & Environmental Medicine
Keigo Sawamoto, Steven B Bird, Yoichi Katayama, Kunihiko Maekawa, Shuji Uemura, Katsutoshi Tanno, Eichi Narimatsu
PURPOSE: This study aimed to identify factors of neurologic prognosis in severe accidental hypothermic patients with cardiac arrest. BASIC PROCEDURES: This retrospective observational study was performed in a tertiary care university hospital in Sapporo, Japan (January 1994 to December 2012). We investigated 26 patients with accidental hypothermic cardiac arrest resuscitated with extracorporeal cardiopulmonary resuscitation (ECPR). We evaluated the neurologic outcome in patients who were resuscitated with ECPR at discharge from hospital...
April 2014: American Journal of Emergency Medicine
Sylweriusz Kosiński, Jakub Jasiński, Stanisław Krzeptowski-Sabała, Jan Gąsienica-Roj, Andrzej Górka
This report presents the case of non-avalanche-related snow immersion death in the Tatra Mountains, which meets all the criteria of this rare phenomenon. The causes and mechanism of deep snow immersion suffocation as well as prevention strategies are discussed.
January 2013: Anaesthesiology Intensive Therapy
David Skarda, Douglass Barnhart, Eric Scaife, Mark Molitor, Rebecka Meyers, Michael Rollins
PURPOSE: We have previously reported the use of EC-CPR for the treatment of hypothermic cardiac arrest with an overall survival of 50%. As we have continued this protocol for an additional 5 years, we sought to update this information. METHODS: We reviewed all of the activations for hypothermic cardiac arrest from 2005 to 2011. Results are presented as means with minimum and maximum values. The 95% confidence interval for the point estimate of survival was calculated using a binomial distribution...
December 2012: Journal of Pediatric Surgery
Hermann Brugger, Bruno Durrer, Fidel Elsensohn, Peter Paal, Giacomo Strapazzon, Eveline Winterberger, Ken Zafren, Jeff Boyd
BACKGROUND: In North America and Europe ∼150 persons are killed by avalanches every year. METHODS: The International Commission for Mountain Emergency Medicine (ICAR MEDCOM) systematically developed evidence-based guidelines and an algorithm for the management of avalanche victims using a worksheet of 27 Population Intervention Comparator Outcome questions. Classification of recommendations and level of evidence are ranked using the American Heart Association system...
May 2013: Resuscitation
Peter Paal, Mario Milani, Douglas Brown, Jeff Boyd, John Ellerton
The aim was to establish scientifically supported recommendations for termination of cardiopulmonary resuscitation (CPR) in mountain rescue, which can be applied by physicians and nonphysicians. A literature search was performed; the results and recommendations were discussed among the authors, and finally approved by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) in October 2011. 4166 abstracts were reviewed; of these, 96 were relevant for this article and are included in this literature review...
September 2012: High Altitude Medicine & Biology
Peter Mair, Christian Frimmel, Gernot Vergeiner, Matthias Hohlrieder, Luca Moroder, Peter Hoesl, Wolfgang Voelckel
BACKGROUND: In the European Alps emergency medical helicopter services are regularly involved in avalanche rescue missions. How the helicopter emergency medical system best supports avalanche rescue missions is controversial. AIM OF THE STUDY: To study advantages and limitations of the early dispatch of emergency medical helicopters after avalanche accidents. METHODS: Data on rescue mission characteristics and patterns and severity of medical emergencies were obtained for 221 helicopter avalanche rescue missions performed in the Austrian province of Tyrol between October 2008 and June 2011...
April 2013: Resuscitation
J Koppenberg, H Brugger, A Esslinger, R Albrecht
This is a case report about a helicopter emergency medical service (HEMS) operation during the night in response to an avalanche accident with two completely buried victims. One of the victims was rescued alive after 9.2 h presenting with a patent airway and an air pocket and was successfully rewarmed with forced air from 23°C core temperature without any neurological deficits. After the rescue the patient developed lung edema which resolved spontaneously within 2 days. The second victim was found dead presenting with an air pocket but solid frozen thorax...
October 2012: Der Anaesthesist
M L Avellanas, A Ricart, J Botella, F Mengelle, I Soteras, T Veres, M Vidal
Accidental hypothermia is an environmental condition with basic principles of classification and resuscitation that apply to mountain, sea or urban scenarios. Along with coagulopathy and acidosis, hypothermia belongs to the lethal triad of trauma victims requiring critical care. A customized healthcare chain is involved in its management, extending from on site assistance to intensive care, cardiac surgery and/or the extracorporeal circulation protocols. A good classification of the degree of hypothermia preceding admission contributes to improve management and avoids inappropriate referrals between hospitals...
April 2012: Medicina Intensiva
Hermann Brugger, Peter Paal, Jeff Boyd
In North America and Europe, approximately 150 people die of avalanches per year, and fatalities are presumed to be many times higher in developing countries. Four factors are decisive for survival: grade of burial, duration of burial, presence of an air pocket and a free airway, and severity of trauma. According to Swiss data, the overall mortality rate with avalanche burial is 23%, but it largely depends on the grade of burial. While the mortality rate is 52.4% in completely buried (head below the snow) victims in the Swiss population, it is only 4...
2011: High Altitude Medicine & Biology
Christoph J Schlimp, Thomas Loimer, Michael B Schmidts, Michael Rieger, Wolfgang Lederer
An 25-year-old man was buried by an avalanche during off-slope skiing. He was rescued by his companions and resuscitated by mouth-to-mouth ventilation. The emergency physician from a helicopter based emergency medical service placed two venous lines in both external jugular veins and secured the airway with a tracheal tube. When transferred to the emergency department an additional central venous catheter was inserted via his right femoral vein. The subsequent computed tomography scan revealed several small air bubbles adjacent to the endothelium of the brachiocephalic vein...
2009: BMJ Case Reports
Pascal Haegeli, Markus Falk, Hermann Brugger, Hans-Jürg Etter, Jeff Boyd
BACKGROUND: Current recommendations for rescue and resuscitation of people buried in avalanches are based on Swiss avalanche survival data. We analyzed Canadian survival patterns and compared them with those from Switzerland. METHODS: We extracted relevant data for survivors and nonsurvivors of complete avalanche burials from Oct. 1, 1980, to Sept. 30, 2005, from Canadian and Swiss databases. We calculated survival curves for Canada with and without trauma-related deaths as well as for different outdoor activities and snow climates...
April 19, 2011: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
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