title: Prehospital management and outcome of avalanche patients with out-of-hospital cardiac arrest: a retrospective study in Tyrol, Austria.
abstract: OBJECTIVE
  The aim of this study is to describe the prehospital management and outcome of avalanche patients with out-of-hospital cardiac arrest in Tyrol, Austria, for the first time since the introduction of international guidelines in 1996.
  
  
  METHODS
  This study involved a retrospective analysis of all avalanche accidents involving out-of-hospital cardiac arrest between 1996 and 2009 in Tyrol, Austria.
  
  
  RESULTS
  A total of 170 completely buried avalanche patients were included. Twenty-eight victims were declared dead at the scene. Of 34 patients with short burial, cardiopulmonary resuscitation (CPR) was performed in 27 (79%); 15 of these patients (56%) were transported to hospital with ongoing CPR and four patients were rewarmed with extracorporeal circulation; no patient survived. Of 108 patients with long burial, 49 patients had patent or unknown airway status; CPR was performed in 25 of these patients (51%) and 14 patients (29%) were transported to hospital. Four patients were rewarmed, but only one patient with witnessed cardiac arrest survived. Since the introduction of guidelines in 1996, there has been a marginally significant increase in the rate of documenting airway assessment, but no change in documenting the duration of burial or CPR.
  
  
  CONCLUSIONS
  CPR is continued to hospital admission in patients with short burial and asphyxial cardiac arrest, but withheld or terminated at the scene in patients with long burial and possible hypothermic cardiac arrest. Insufficient transfer of information from the accident site to the hospital may partially explain the poor outcome of avalanche victims with out-of-hospital cardiac arrest treated with emergency cardiac care.
authors.affiliation: aInstitute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy Departments of bAnesthesiology and Critical Care Medicine cCardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Strapazzon
authors.forename: Judith
authors.initials: J
authors.lastname: Plankensteiner
authors.forename: Peter
authors.initials: P
authors.lastname: Mair
authors.forename: Elfriede
authors.initials: E
authors.lastname: Ruttmann
authors.forename: Tomas
authors.initials: T
authors.lastname: Dal Cappello
authors.forename: Emily
authors.initials: E
authors.lastname: Procter
authors.forename: Hermann
authors.initials: H
authors.lastname: Brugger
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001317:Austria; D055875:Avalanches / Q000401:mortality*; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D017694:Rewarming / Q000379:methods; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D014218:Triage; D055815:Young Adult