title: Outcome of avalanche victims with out-of-hospital cardiac arrest.
abstract: BACKGROUND
  Previous studies focused on the outcome of avalanche victims with out-of-hospital cardiac arrest (OHCA) after long duration of burial (>35min); the outcome of victims with short duration (≤35min) remains obscure.
  
  
  OBJECTIVE
  To investigate outcome of avalanche victims with OHCA.
  
  
  METHODS
  Retrospective analysis of avalanche victims with OHCA between 2008 and 2013 in the Tyrolean Alps.
  
  
  RESULTS
  55 avalanche victims were identified, 32 of whom were declared dead after extrication without cardiopulmonary resuscitation (CPR), all with long duration of burial. In the remaining 23 CPR was initiated at scene; three were partially and 20 completely buried, nine of whom suffered short and 11 long duration of burial. All nine victims with short duration of burial underwent restoration of spontaneous circulation (ROSC) at scene, four of them after bystander CPR, five after advanced life support by the emergency physician. Two patients with ROSC after short duration of burial and bystander CPR survived to hospital discharge with cerebral performance category 1. None of the 11 victims with long duration of burial survived to hospital discharge, although six were transported to hospital with ongoing CPR and three were supported with extracorporeal circulation.
  
  
  CONCLUSIONS
  In this case series survival with favourable neurological outcome was observed in avalanche victims with short duration of burial only if bystander CPR was immediately performed and ROSC achieved. Strategies for reducing avalanche mortality should focus on prompt extrication from the snow and immediate bystander CPR by uninjured companions.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Luca
authors.initials: L
authors.lastname: Moroder
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; Christophorus Emergency Medical Helicopter Service, Schubertring 1-3, 1010 Vienna, Austria.
authors.forename: Birgit
authors.initials: B
authors.lastname: Mair
authors.affiliation: Institute of Mountain Emergency Medicine, EURAC Research, Viale Druso 1, 39100 Bolzano, Italy.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brugger
authors.affiliation: Christophorus Emergency Medical Helicopter Service, Schubertring 1-3, 1010 Vienna, Austria; Department of Anesthesiology and Critical Care Medicine, AUVA Trauma Hospital Salzburg, Dr.-Franz-Rehrl-Platz 4, 5010 Salzburg, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Voelckel
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; Christophorus Emergency Medical Helicopter Service, Schubertring 1-3, 1010 Vienna, Austria. Electronic address: p.mair@uki.at.
authors.forename: Peter
authors.initials: P
authors.lastname: Mair
mesh_terms: D000328:Adult; D000368:Aged; D055875:Avalanches / Q000401:mortality*; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment
keywords: Asphyxia; Avalanche; Bystander; Cardiopulmonary resuscitation; Outcome