Secondary Prevention of HAPE in a Mount Everest Summiteer

Abstract

Climbers who have suffered a previous episode of high altitude pulmonary edema (HAPE) are at significantly increased risk of developing it again on return to high altitude. In spite of the high mortality associated with HAPE, some climbers are willing to take this risk in order to summit the tallest mountains in the world. This is a case report of a climber who suffered an episode of HAPE partway up Mount Everest. He was determined to complete his summit attempt that same climbing season, which would involve a return to extreme altitude less than 3 weeks following recovery. Based on experimental evidence suggesting that sildenafil, salmeterol, and acetazolamide may have therapeutic value for both the prevention and treatment of HAPE, he used these medications for secondary prevention. He was able to successfully reach the summit of Mount Everest and return to base camp without any evidence of recurrence of pulmonary edema. This provides clinical evidence that medication can be used to increase the safety margin for HAPE-susceptible individuals traveling to extremely high altitudes.

Acute high-altitude sickness

“…Although reports document successful ascents of Mount Everest following episodes of HAPE [138,139], the safety of continuing ascent after resolution of HAPE or HACE remains controversial. If ascent is pursued in such circumstances, the individual should be symptom-free and off any medications for at least several days before initiating further ascent and should strongly consider pharmacological prophylaxis for their ascent, including a pulmonary vasodilator for individuals who had HAPE and dexamethasone for individuals who had HACE.…”

Real-Time Electrocardiogram Transmission from Mount Everest during Continued Ascent

“…Climbers on Mount Everest are at risk of developing potentially fatal high altitude illness (such as high altitude pulmonary edema [HAPE] and high altitude cerebral edema [HACE]) [12], [13]. Resting tachypnea and tachycardia are the major signs for HAPE [12].…”

“…Dunin-Bell and Boyle [13] previously reported a 38-year-old male who suffered from high altitude pulmonary edema who presented with a heart rate of 125 bpm (68.7% of his MAHR) at base camp – much higher than the mean RHR of 70 bpm at base camp reported by Karliner et al [8], 83 bpm for follow-ups group at base camp reported by Wiseman et al [19], and 76 bpm by Agostoni et al [20]. Huey et al [21] reported that the likelihood of summiting Mount Everest declined dramatically after the age of 40 and mortality rate was increased dramatically after the age of 60.…”

High Altitude Illness

“…One case report describes the use of a combination of salmetarol, acetazolamide and sildenafil as chemoprophylaxis in a successful ascent of Mt Everest in a climber who had suffered an episode of HAPE on that mountain some three weeks previously during a previous attempt on the summit [19].…”