Survival after avalanche-induced cardiac arrest

Yvonnick Boué, Jean François Payen, Julien Brun, Sébastien Thomas, Albrice Levrat, Marc Blancher, Guillaume Debaty, Pierre Bouzat

Research output: Contribution to journalArticlepeer-review

Abstract

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. Neurological outcome was assessed at 3 months using cerebral performance category score. Results: Forty-eight patients were studied. They were buried for a median time of 43. min (25-76. min; 25-75th percentiles) and had a pre-hospital body core temperature of 28.0. °C (26.0-30.7). Eighteen patients (37.5%) had pre-hospital return of spontaneous circulation and 30 had refractory CA. Rewarming of 21 patients (43.7%) was performed using extracorporeal life support. Eight patients (16.7%) survived and were discharged from the ICU, three (6.3%) had favorable neurological outcome at 3 months. Pre-hospital parameters associated with survival were the presence of an air pocket and rescue collapse. On admission, survivors had lower serum potassium concentrations than non-survivors: 3.2. mmol/L (2.7-4.0) versus 5.6. mmol/L (4.2-8.0), respectively (P<. 0.01). They also had normal values for prothrombin and activated partial thromboplastin compared to non-survivors. Conclusions: Our findings indicate that survival after avalanche burial and on-scene CA is rarely associated with favorable neurological outcome. Among criteria associated with survival, normal blood coagulation on admission warrants further investigation.

Original languageEnglish (US)
Pages (from-to)1192-1196
Number of pages5
JournalResuscitation
Volume85
Issue number9
DOIs
StatePublished - Sep 2014

Keywords

  • Avalanche
  • Burial
  • Cardiac arrest
  • Hypothermia

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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