Survival probability in avalanche victims with long burial (≥60 min): A retrospective study

Abstract

Background: The survival of completely buried victims in an avalanche mainly depends on burial duration. Knowledge is limited about survival probability after 60 min of complete burial. Aim:We aimed to study the survival probability and prehospital characteristics of avalanche victims with long burial durations. Methods:We retrospectively included all completely buried avalanche victims with a burial duration of !60 min between 1997 and 2018 in Switzerland.Data were extracted from the registry of the Swiss Institute for Snow and Avalanche Research and the prehospital medical records of the physicianstaffed helicopter emergency medical services. Avalanche victims buried for !24 h or with an unknown survival status were excluded. Survival probability was estimated by using the non-parametric AyerÀTurnbull method and logistic regression. The primary outcome was survival probability.Results: We identified 140 avalanche victims with a burial duration of !60 min, of whom 27 (19%) survived. Survival probability shows a slight decrease with increasing burial duration (23% after 60 min, to <6% after 1400 min, p = 0.13). Burial depth was deeper for those who died (100 cm vs 70 cm, p = 0.008). None of the survivors sustained CA during the prehospital phase. Conclusions:The overall survival rate of 19% for completely buried avalanche victims with a long burial duration illustrates the importance of continuing rescue efforts. Avalanche victims in CA after long burial duration without obstructed airway, frozen body or obvious lethal trauma should be considered to be in hypothermic CA, with initiation of cardiopulmonary resuscitation and an evaluation for rewarming with extracorporeal life support.

Surviving 20 Hours of Critical Avalanche Burial and a Core Temperature of 22.5 °C

“…A retrospective study analyzed the survival probability in avalanche victims with long burial (≥60 min) and identified several correlating parameters 4 : the median burial depth of survivors (70 cm) was significantly more superficial than for those who died (100 cm). 4 Our avalanche victim survived, despite being buried 230 cm below the snow surface, therefore contradicting this study. The same study reported that the estimated survival probability dropped from 23% after 60 min of burial duration to less than 6% after 1400 min, approximately 24 h. 4 The odds ratio of the decrease in survival was 0.93 per hour.…”

“…[1][2][3] Reasons for a good outcome after long avalanche burial in an open area include the presence of a large or open-air pocket, no obvious major injuries, victims well insulated to avoid fast and critical cooling within hours, and no hypothermic or asphyctic cardiac arrest. A retrospective study analyzed the survival probability in avalanche victims with long burial (≥60 min) and identified several correlating parameters 4 : the median burial depth of survivors (70 cm) was significantly more superficial than for those who died (100 cm). 4 Our avalanche victim survived, despite being buried 230 cm below the snow surface, therefore contradicting this study.…”

Electromagnetic Interference from Heated Gloves May Compromise Avalanche Transceiver Function

“…Delayed extrication of avalanche victims is associated with reduced survival and worsened clinical outcome. 4,17,18 Rescue algorithms for avalanche accidents should consider the potential of prolonged search and rescue missions from EMI caused by electric devices. 5,19 Furthermore, EMI caused by HE was more pronounced in rescuer ATs.…”

Quality Indicators for Avalanche Victim Management and Rescue

“…The widespread belief that victims with long burial times have less chance of survival is incorrect. Victims with long burials who are not asphyxiated may be protected from brain injury by hypothermia and can have good neurological outcomes [6,30]. Resuscitation efforts should be withheld, according to BLS guidelines, if the victim is not hypothermic (QI 14) or if the victim has had a long burial with obstructed airway and asystole (QI 15).…”