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Resuscitation. 2013 May;84(5):539-46. doi: 10.1016/j.resuscitation.2012.10.020. Epub 2012 Nov 2.

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.

Author information

  • 1International Commission for Mountain Emergency Medicine ICAR MEDCOM, Institute of Mountain Emergency Medicine, EURAC Research, Drususallee 1, I-39100 Bozen/Bolzano, Italy. hermann.brugger@eurac.edu

Abstract

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.

RESULTS AND CONCLUSIONS:

If lethal injuries are excluded and the body is not frozen, the rescue strategy is governed by the duration of snow burial and, if not available, by the victim's core-temperature. If burial time ≤35 min (or core-temperature ≥32 °C) rapid extrication and standard ALS is important. If burial time >35 min and core-temperature <32 °C, treatment of hypothermia including gentle extrication, full body insulation, ECG and core-temperature monitoring is recommended, and advanced airway management if appropriate. Unresponsive patients presenting with vital signs should be transported to a hospital capable of active external and minimally invasive rewarming such as forced air rewarming. Patients with cardiac instability or in cardiac arrest (with a patent airway) should be transported to a hospital for extracorporeal membrane oxygenation or cardiopulmonary bypass rewarming. Patients in cardiac arrest should receive uninterrupted CPR; with asystole, CPR may be terminated (or withheld) if a patient is lethally injured or completely frozen, the airway is blocked and duration of burial >35 min, serum potassium >12 mmol L(-1), risk to the rescuers is unacceptably high or a valid do-not-resuscitate order exists. Management should include spinal precautions and other trauma care as indicated.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

[PubMed - indexed for MEDLINE]
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