Avalanche Patient Resuscitation

Aka: Avalanche Patient Resuscitation, Cardiac Arrest in Avalanche Victim, Avalanche

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II. Causes: Cardiac Arrest in Avalanche Patients

  1. Cardiac Arrest <35 minutes after Avalanche
    1. Asphyxia (airway impacted with snow)
    2. Trauma with lethal injury
  2. Cardiac Arrest >35 minutes after Avalanche
    1. Hypothermia

III. Prognosis

  1. Retrieval within 10 minutes: 77% chance of survival
  2. Retrieval after 35 minutes: 7% chance of survival
    1. Snow impacted airway at >35 minutes: 0% chance of survival
    2. Clear airway at >35 minutes has greater chance of ROSC on rewarming from Hypothermia
  3. Other markers of poor prognosis
    1. Serum Potassium >8 mg/dl in Avalanche victim (>12 mg/dl in Hypothermia only victim)

IV. Prognosis: HOPE Score

  1. Criteria
    1. Age
    2. Gender
    3. CPR duration
    4. Serum Potassium
    5. Core Temperature
    6. Asphyxia findings
  2. Interpretation
    1. HOPE Score with Survival >10% indicates ECMO
  3. Resources: Hope Score Calculator
    1. https://www.hypothermiascore.org/

V. Management: European Resuscitation Council (ERC)

  1. See Hypothermia Management
  2. Indication to stop Resuscitation
    1. Signs of lethal injury
    2. Completely frozen body
  3. Retrieval <60 minutes after Avalanche AND core Temperature >30 C (86 F)
    1. Standard ACLS protocol
  4. Retrieval <60 minutes after Avalanche AND core Temperature <30 C (86 F)
    1. Observe for signs of life
    2. Check pulse and breathing for one minute
    3. Any spontaneous cardiopulmonary activity suggests Hypothermia, and initiate rewarming
    4. ECMO is indicated in hemodynamic instability or core Temperature <28 C (82.4 F)
  5. Retrieval >60 minutes after Avalanche AND core Temperature <30 C (86 F)
    1. Observe for signs of life
    2. Check pulse and breathing for one minute
      1. Start CPR if no pulse of breathing
    3. Check EKG
      1. PEA or VT/VF
        1. Continue CPR
        2. Consult ECMO facility
        3. See Hypothermia Management regarding Defibrillation in Hypothermia, Epinephrine
          1. European guidelines do not use Defibrillation or Epinephrine until temp >30 C (86 F)
      2. Asystole is a poor prognostic sign even in Hypothermia
        1. Evaluate HOPE Score and consider Stopping Resuscitation

VI. Resources

  1. Avalanche Victim Resuscitation Checklist
    1. https://www.resuscitationjournal.com/action/showPdf?pii=S0300-9572%2817%2930020-5

VII. References

  1. Candy and Content in Herbert (2021) EM:Rap 21(12): 2-4

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