title: Factors affecting survival from avalanche burial--a randomised prospective porcine pilot study.
abstract: OBJECTIVE
  The majority of avalanche victims who sustain complete burial die within 35min due to asphyxia and injuries. After 35min, survival is possible only in the presence of a patent airway, and an accompanying air pocket around the face may improve survival. At this stage hypothermia is assumed to be an important factor for survival because rapid cooling decreases oxygen consumption; if deep hypothermia develops before cardiac arrest, hypothermia may be protective and prolong the time that cardiac arrest can be survived. The aim of the study was to investigate the combined effects of hypoxia, hypercapnia and hypothermia in a porcine model of avalanche burial.
  
  
  METHODS
  Eight piglets were anaesthetised, intubated and buried under snow, randomly assigned to an air pocket (n=5) or ambient air (n=3) group.
  
  
  RESULTS
  Mean cooling rates in the first 10min of burial were -19.7±4.7°Ch(-1) in the air pocket group and -13.0±4.4°Ch(-1) in the ambient air group (P=0.095); overall cooling rates between baseline and asystole were -4.7±1.4°Ch(-1) and -4.6±0.2°Ch(-1) (P=0.855), respectively. In the air pocket group cardiac output (P=0.002), arterial oxygen partial pressure (P=0.001), arterial pH (P=0.002) and time to asystole (P=0.025) were lower, while arterial carbon dioxide partial pressure (P=0.007) and serum potassium (P=0.042) were higher compared to the ambient air group.
  
  
  CONCLUSIONS
  Our results demonstrate that hypothermia may develop in the early phase of avalanche burial and severe asphyxia may occur even in the presence of an air pocket.
authors: Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria. peter.paal@uki.at
authors: Peter
authors: P
authors: Paal
authors: Giacomo
authors: G
authors: Strapazzon
authors: Patrick
authors: P
authors: Braun
authors: Peter Paul
authors: PP
authors: Ellmauer
authors: Daniel Carl
authors: DC
authors: Schroeder
authors: Guenther
authors: G
authors: Sumann
authors: Andreas
authors: A
authors: Werner
authors: Volker
authors: V
authors: Wenzel
authors: Markus
authors: M
authors: Falk
authors: Hermann
authors: H
authors: Brugger
mesh_terms: D000818:Animals; D001237:Asphyxia / Q000209:etiology; D055875:Avalanches; D005260:Female; D006935:Hypercapnia / Q000209:etiology; D007035:Hypothermia / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D011897:Random Allocation; D013534:Survival; D013552:Swine