Snow avalanche deaths in Switzerland from 1995 to 2014-Results of a nation-wide linkage study

Noncompressible Chest Wall in Critically Buried Avalanche Victims with Cardiac Arrest: A Case Series

David Eidenbenz, Alexandre Kottmann, Ken Zafren, Pierre-Nicolas Carron, Roland Albrecht, and Mathieu Pasquier. Noncompressible chest wall in critically buried avalanche victims with cardiac arrest: a case series. High Alt Med Biol. 00:00-00, 2024. Introduction: In avalanche victims with cardiac arrest, a noncompressible chest wall or frozen body is a contraindication to initiating cardiopulmonary resuscitation. The evidence sustaining this recommendation is low. Objective: To describe the characteristics and prehospital management of critically buried avalanche victims declared dead on site, with and without noncompressible chest walls. Methods: Retrospective study including all critically buried avalanche victims declared dead on site by physicians of a helicopter emergency medical service in Switzerland, from 2010 to 2019. The primary outcome was the proportion of victims with a noncompressible chest wall reported in medical records. Secondary outcomes included victims' characteristics and the relevance of the criterion, noncompressible chest wall, for management. Results: Among the 53 included victims, 12 (23%) had noncompressible chest walls. Victims with noncompressible chest walls had significantly longer burial durations (median 1,125 vs. 45 minutes; p < 0.001) and lower core temperatures (median 14 vs. 32°C; p = 0.01). The criterion, noncompressible chest wall, assessed in six victims, was decisive for declaring death on site in four victims. Conclusion: The presence of a noncompressible chest wall does not appear to be a sufficient criterion to allow to declare the death of critically buried avalanche victims. Further clinical information should be sought.

Survival probability in avalanche victims with long burial (≥60 min): A retrospective study

BACKGROUND

The survival of completely buried victims in an avalanche mainly depends on burial duration. Knowledge is limited about survival probability after 60 min of complete burial.

AIM

We aimed to study the survival probability and prehospital characteristics of avalanche victims with long burial durations.

METHODS

We retrospectively included all completely buried avalanche victims with a burial duration of ≥60 min between 1997 and 2018 in Switzerland. Data were extracted from the registry of the Swiss Institute for Snow and Avalanche Research and the prehospital medical records of the physician-staffed helicopter emergency medical services. Avalanche victims buried for ≥24 h or with an unknown survival status were excluded. Survival probability was estimated by using the non-parametric Ayer-Turnbull method and logistic regression. The primary outcome was survival probability.

RESULTS

We identified 140 avalanche victims with a burial duration of ≥60 min, of whom 27 (19%) survived. Survival probability shows a slight decrease with increasing burial duration (23% after 60 min, to <6% after 1400 min, p = 0.13). Burial depth was deeper for those who died (100 cm vs 70 cm, p = 0.008). None of the survivors sustained CA during the prehospital phase.

CONCLUSIONS

The overall survival rate of 19% for completely buried avalanche victims with a long burial duration illustrates the importance of continuing rescue efforts. Avalanche victims in CA after long burial duration without obstructed airway, frozen body or obvious lethal trauma should be considered to be in hypothermic CA, with initiation of cardiopulmonary resuscitation and an evaluation for rewarming with extracorporeal life support.