Critically buried avalanche victims can develop severe hypothermia in less than 60 min
Abstract Background A major challenge in the management of avalanche victims in cardiac arrest is differentiating hypothermic from non-hypothermic cardiac arrest, as management and prognosis differ. Duration of burial with a cutoff of 60 min is currently recommended by the resuscitation guidelines a...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13049-023-01092-y |
| _version_ | 1797801253014601728 |
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| author | Simon Rauch Julia Kompatscher Andreas Clara Iris Öttl Giacomo Strapazzon Marc Kaufmann |
| author_facet | Simon Rauch Julia Kompatscher Andreas Clara Iris Öttl Giacomo Strapazzon Marc Kaufmann |
| author_sort | Simon Rauch |
| collection | DOAJ |
| description | Abstract Background A major challenge in the management of avalanche victims in cardiac arrest is differentiating hypothermic from non-hypothermic cardiac arrest, as management and prognosis differ. Duration of burial with a cutoff of 60 min is currently recommended by the resuscitation guidelines as a parameter to aid in this differentiation However, the fastest cooling rate under the snow reported so far is 9.4 °C per hour, suggesting that it would take 45 min to cool below 30 °C, which is the temperature threshold below which a hypothermic cardiac arrest can occur. Case presentation We describe a case with a cooling rate of 14 °C per hour, assessed on site with an oesophageal temperature probe. This is by far the most rapid cooling rate after critical avalanche burial reported in the literature and further challenges the recommended 60 min threshold for triage decisions. The patient was transported under continuous mechanical CPR to an ECLS facility and rewarmed with VA-ECMO, although his HOPE score was 3% only. After three days he developed brain death and became an organ donor. Conclusions With this case we would like to underline three important aspects: first, whenever possible, core body temperature should be used instead of burial duration to make triage decisions. Second, the HOPE score, which is not well validated for avalanche victims, had a good discriminatory ability in our case. Third, although extracorporeal rewarming was futile for the patient, he donated his organs. Thus, even if the probability of survival of a hypothermic avalanche patient is low based on the HOPE score, ECLS should not be withheld by default and the possibility of organ donation should be considered. |
| first_indexed | 2024-03-13T04:47:38Z |
| format | Article |
| id | doaj.art-9736ccae3d954412a35c0b34237755f9 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-03-13T04:47:38Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-9736ccae3d954412a35c0b34237755f92023-06-18T11:23:34ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412023-06-013111410.1186/s13049-023-01092-yCritically buried avalanche victims can develop severe hypothermia in less than 60 minSimon Rauch0Julia Kompatscher1Andreas Clara2Iris Öttl3Giacomo Strapazzon4Marc Kaufmann5Institute of Mountain Emergency Medicine, Eurac ResearchDepartment of Emergency Medicine, Anaesthesia and Intensive Care Medicine, Hospital of BolzanoAiut Alpin Dolomites Helicopter Emergency Medical ServiceDepartment of Emergency Medicine, Anaesthesia and Intensive Care Medicine, Hospital of BolzanoInstitute of Mountain Emergency Medicine, Eurac ResearchDepartment of Emergency Medicine, Anaesthesia and Intensive Care Medicine, Hospital of BolzanoAbstract Background A major challenge in the management of avalanche victims in cardiac arrest is differentiating hypothermic from non-hypothermic cardiac arrest, as management and prognosis differ. Duration of burial with a cutoff of 60 min is currently recommended by the resuscitation guidelines as a parameter to aid in this differentiation However, the fastest cooling rate under the snow reported so far is 9.4 °C per hour, suggesting that it would take 45 min to cool below 30 °C, which is the temperature threshold below which a hypothermic cardiac arrest can occur. Case presentation We describe a case with a cooling rate of 14 °C per hour, assessed on site with an oesophageal temperature probe. This is by far the most rapid cooling rate after critical avalanche burial reported in the literature and further challenges the recommended 60 min threshold for triage decisions. The patient was transported under continuous mechanical CPR to an ECLS facility and rewarmed with VA-ECMO, although his HOPE score was 3% only. After three days he developed brain death and became an organ donor. Conclusions With this case we would like to underline three important aspects: first, whenever possible, core body temperature should be used instead of burial duration to make triage decisions. Second, the HOPE score, which is not well validated for avalanche victims, had a good discriminatory ability in our case. Third, although extracorporeal rewarming was futile for the patient, he donated his organs. Thus, even if the probability of survival of a hypothermic avalanche patient is low based on the HOPE score, ECLS should not be withheld by default and the possibility of organ donation should be considered.https://doi.org/10.1186/s13049-023-01092-yAvalancheAvalanche burialAccidental hypothermiaExtracorporeal rewarmingHOPE scoreOrgan donation |
| spellingShingle | Simon Rauch Julia Kompatscher Andreas Clara Iris Öttl Giacomo Strapazzon Marc Kaufmann Critically buried avalanche victims can develop severe hypothermia in less than 60 min Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Avalanche Avalanche burial Accidental hypothermia Extracorporeal rewarming HOPE score Organ donation |
| title | Critically buried avalanche victims can develop severe hypothermia in less than 60 min |
| title_full | Critically buried avalanche victims can develop severe hypothermia in less than 60 min |
| title_fullStr | Critically buried avalanche victims can develop severe hypothermia in less than 60 min |
| title_full_unstemmed | Critically buried avalanche victims can develop severe hypothermia in less than 60 min |
| title_short | Critically buried avalanche victims can develop severe hypothermia in less than 60 min |
| title_sort | critically buried avalanche victims can develop severe hypothermia in less than 60 min |
| topic | Avalanche Avalanche burial Accidental hypothermia Extracorporeal rewarming HOPE score Organ donation |
| url | https://doi.org/10.1186/s13049-023-01092-y |
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