Citation

Boué Y, Payen JF, Brun J, Thomas S, Levrat A, Blancher M, Debaty G, Bouzat P. Resuscitation 2014; 85(9): 1192-1196.

Affiliation

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.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.resuscitation.2014.06.015

PMID

24971508

Abstract

AIM: 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 43min (25-76min; 25-75(th) 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: 3.2mmol/L (2.7-4.0) versus 5.6mmol/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 favourable neurological outcome. Among criteria associated with survival, normal blood coagulation on admission warrants further investigation.

Language: en