Avalanche victims in cardiac arrest are unlikely to survive despite adherence to medical guidelines

Abstract Aims Our goals were to describe and analyse the medical management and clinical course of avalanche victims in cardiac arrest (CA), focusing on adherence to international recommendations on avalanche victims in CA regarding critical decisions. Methods We retrospectively included all avalanche victims with CA from 1st January 2004 to 1st June 2016 in a single physician-staffed alpine helicopter emergency medical service. Data regarding cardiopulmonary resuscitation (CPR), transportation to hospital whilst undergoing CPR, and extracorporeal life support rewarming (ECLSR) for patients still in CA at hospital admission were abstracted from the prehospital and medical health records. Results Sixty-six victims were included in this study; 31 (47%) were declared dead on scene. Of the remaining 35 victims, 7 (20%) had prehospital return of spontaneous circulation (ROSC), 28 (80%) were transported whilst undergoing CPR, 3 had hospital ROSC and 7 (28%) of the 25 patients with persistent CA at hospital underwent ECLSR. The medical management comprised 126 documented critical decisions, corresponding to guidelines in 117 (93%) decisions. None of the 66 studied patients survived to hospital discharge, and 7 (11%) were organ donors. Conclusions The management of avalanche victims in CA respect current guidelines regarding the critical decisions, but no patient survived in this sample. The presence of a few cases with incorrect management and potential undertreatment suggests some room for improvement.