The Death Zone: Lessons from History

Abstract

This Lessons from History article about the naming of the extreme altitude "Death Zone" explores the historical mountaineering and medical literature relevant to the topic. Swiss alpinist and radiologist Edouard Wyss-Dunant (1897e1983) authored several reports and books about expeditions to arctic regions, deserts, and the Himalaya. Encouraged by the success of a Swiss expedition to the Garhwal Himalaya in 1947, Wyss-Dunant joined his fellow climbers from Geneva on a 1949 expedition to several peaks in the Kanchenjunga region. Wyss-Dunant was then invited to lead the spring 1952 Swiss Everest expedition. Despite this being the first Swiss attempt on Everest and on an untried route, Raymond Lambert and Tenzing Norgay nearly summitted Everest from the Nepal side. Wyss-Dunant earned mountaineering immortality by coining the phrase the Death Zone during the expedition's foray into the upper regions of Everest. Wyss-Dunant went on to become a president of the Swiss Alpine Club and the International Climbing and Mountaineering Federation. His writings and that of others provide an evocative supporting narrative to illustrate some of the problems of living (or dying) at extreme altitude.

Respiratory Changes and Acid–Base Compensation: Watch the Salt

“…Researchers estimate that 1 in 160, or about 2 million people, living in the United States alone have obesity hypoventilation syndrome with an awake Pa co 2 greater than 45 mmHg, 11 and that more than 250,000 people in the United States have severe chronic obstructive pulmonary disease and hypercapnia with Pa co 2 greater than 50 mmHg. 12 In the mirror image of chronic respiratory alkalosis, although very few spend more than a day in the extreme altitude “death zone” above 8,000 m (26,250 feet), 13 more than 80 million people worldwide live in what is a physiologically habitable high-altitude zone between 2,500 and 5,500 m (6,000 to 18,000 feet). 14 However, the largest group of people with chronic respiratory alkalosis likely to receive anesthesia care are women during pregnancy who typically have a Pa co 2 of about 31 mmHg and base-excess of -3.3 mM in the third trimester.…”