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Resuscitation. 2019 Jun;139:222-229. doi: 10.1016/j.resuscitation.2019.04.025. Epub 2019 Apr 22.

Cut-off values of serum potassium and core temperature at hospital admission for extracorporeal rewarming of avalanche victims in cardiac arrest: A retrospective multi-centre study.

Author information

1
Institute of Mountain Emergency Medicine, EURAC research, Drususallee 1, 39100 Bolzano, Italy; Medical University Innsbruck, Austria; International Commission for Mountain Emergency Medicine ICAR MEDCOM. Electronic address: hermann.brugger@eurac.edu.
2
Department of Anaesthesiology and Critical Care, Grenoble Alps Trauma Center, University Hospital of Grenoble- Alpes, 38043 Grenoble Cedex 09, France. Electronic address: PBouzat@chu-grenoble.fr.
3
International Commission for Mountain Emergency Medicine ICAR MEDCOM; Emergency Service, Lausanne University Hospital Center, BH 09, CHUV, CH-1011 Lausanne, Switzerland. Electronic address: Mathieu.Pasquier@chuv.ch.
4
Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. Electronic address: p.mair@tirol-kliniken.at.
5
International Commission for Mountain Emergency Medicine ICAR MEDCOM; Division of Surgical Medicine and Intensive Care, University hospital of North Norway, Tromsø, Norway; Anaesthesia and critical care research group, The Artic University of Norway, 9037 Tromsø, Norway. Electronic address: juliafieler@gmail.com.
6
Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Medykow 14, 40-752 Katowice, Poland. Electronic address: tomekdarocha@wp.pl.
7
International Commission for Mountain Emergency Medicine ICAR MEDCOM; Department of Emergency Medicine, University Hospital of Grenoble-Alpes, France; French Mountain Rescue Association ANMSM, 38043 Grenoble Cedex 09, France. Electronic address: MBlancher@chu-grenoble.fr.
8
Department of Emergency Medicine, Sion Hospital, Sion, Switzerland. Electronic address: matderied@yahoo.fr.
9
Institute of Mountain Emergency Medicine, EURAC research, Drususallee 1, 39100 Bolzano, Italy. Electronic address: falk@e-science.eu.
10
International Commission for Mountain Emergency Medicine ICAR MEDCOM; Department of Anaesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University, Kajetanerplatz 1, 5020 Salzburg, Austria. Electronic address: peter.paal@icloud.com.
11
Institute of Mountain Emergency Medicine, EURAC research, Drususallee 1, 39100 Bolzano, Italy; International Commission for Mountain Emergency Medicine ICAR MEDCOM. Electronic address: giacomo.strapazzon@eurac.edu.
12
International Commission for Mountain Emergency Medicine ICAR MEDCOM; Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA. Electronic address: zafren@stanford.edu.
13
Institute of Mountain Emergency Medicine, EURAC research, Drususallee 1, 39100 Bolzano, Italy; Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland. Electronic address: monika.brodmann@eurac.edu.

Abstract

AIM:

Evidence of existing guidelines for the on-site triage of avalanche victims is limited and adherence suboptimal. This study attempted to find reliable cut-off values for the identification of hypothermic avalanche victims with reversible out-of-hospital cardiac arrest (OHCA) at hospital admission. This may enable hospitals to allocate extracorporeal life support (ECLS) resources more appropriately while increasing the proportion of survivors among rewarmed victims.

METHODS:

All avalanche victims with OHCA admitted to seven centres in Europe capable of ECLS from 1995 to 2016 were included. Optimal cut-off values, for parameters identified by logistic regression, were determined by means of bootstrapping and exact binomial distribution and served to calculate sensitivity, rate of overtriage, positive and negative predictive values, and receiver operating curves.

RESULTS:

In total, 103 avalanche victims with OHCA were included. Of the 103 patients 61 (58%) were rewarmed by ECLS. Six (10%) of the rewarmed patients survived whilst 55 (90%) died. We obtained optimal cut-off values of 7 mmol/L for serum potassium and 30 °C for core temperature.

CONCLUSION:

For in-hospital triage of avalanche victims admitted with OHCA, serum potassium accurately predicts survival. The combination of the cut-offs 7 mmol/L for serum potassium and 30 °C for core temperature achieved the lowest overtriage rate (47%) and the highest positive predictive value (19%), with a sensitivity of 100% for survivors. The presence of vital signs at extrication is strongly associated with survival. For further optimisation of in-hospital triage, larger datasets are needed to include additional parameters.

KEYWORDS:

Avalanche; Extracorporeal life support; Hypothermia; Out-of-hospital cardiac arrest; Serum potassium

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