title: Survival after avalanche-induced cardiac arrest.
abstract: OBJECTIVE
  Criteria to prolong resuscitation after cardiac arrest (CA) induced by complete avalanche burial are critical since profound hypothermia could be involved. We sought parameters associated with survival in a cohort of victims of complete avalanche burial.
  
  
  METHODS
  Retrospective observational study of patients suffering CA on-scene after avalanche burial in the Northern French Alps between 1994 and 2013. Criteria associated with survival at discharge from the intensive care unit (ICU) were collected on scene and upon admission to Level-1 trauma center. Neurological outcome was assessed at 3 months using cerebral performance category score.
  
  
  RESULTS
  Forty-eight patients were studied. They were buried for a median time of 43 min (25-76 min; 25-75th percentiles) and had a pre-hospital body core temperature of 28.0°C (26.0-30.7). Eighteen patients (37.5%) had pre-hospital return of spontaneous circulation and 30 had refractory CA. Rewarming of 21 patients (43.7%) was performed using extracorporeal life support. Eight patients (16.7%) survived and were discharged from the ICU, three (6.3%) had favorable neurological outcome at 3 months. Pre-hospital parameters associated with survival were the presence of an air pocket and rescue collapse. On admission, survivors had lower serum potassium concentrations than non-survivors: 3.2 mmol/L (2.7-4.0) versus 5.6 mmol/L (4.2-8.0), respectively (P<0.01). They also had normal values for prothrombin and activated partial thromboplastin compared to non-survivors.
  
  
  CONCLUSIONS
  Our findings indicate that survival after avalanche burial and on-scene CA is rarely associated with favorable neurological outcome. Among criteria associated with survival, normal blood coagulation on admission warrants further investigation.
authors: Pole Anesthésie-Réanimation, Hôpital Michallon, Grenoble F-38043, France; Université Joseph Fourier, Grenoble Institut des Neurosciences, Grenoble F-38043, France; INSERM, U836, Grenoble F-38042, France.
authors: Yvonnick
authors: Y
authors: Boué
authors: Pole Anesthésie-Réanimation, Hôpital Michallon, Grenoble F-38043, France; Université Joseph Fourier, Grenoble Institut des Neurosciences, Grenoble F-38043, France; INSERM, U836, Grenoble F-38042, France.
authors: Jean-François
authors: JF
authors: Payen
authors: Pole Anesthésie-Réanimation, Hôpital Michallon, Grenoble F-38043, France.
authors: Julien
authors: J
authors: Brun
authors: Pole Anesthésie-Réanimation, Hôpital Michallon, Grenoble F-38043, France.
authors: Sébastien
authors: S
authors: Thomas
authors: Service réanimation, Centre Hospitalier Région d'Annecy, Metz-Tessy, F-74370, France.
authors: Albrice
authors: A
authors: Levrat
authors: Service Urgences-SAMU-SMUR, Hopital Michallon, Grenoble F-38043, France.
authors: Marc
authors: M
authors: Blancher
authors: Service Urgences-SAMU-SMUR, Hopital Michallon, Grenoble F-38043, France.
authors: Guillaume
authors: G
authors: Debaty
authors: Pole Anesthésie-Réanimation, Hôpital Michallon, Grenoble F-38043, France; Université Joseph Fourier, Grenoble Institut des Neurosciences, Grenoble F-38043, France; INSERM, U836, Grenoble F-38042, France. Electronic address: PBouzat@chu-grenoble.fr.
authors: Pierre
authors: P
authors: Bouzat
mesh_terms: D000328:Adult; D055875:Avalanches; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D012151:Resuscitation; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: Avalanche; Burial; Cardiac arrest; Hypothermia