The International Commission for Alpine Emergency Medicine (ICAR MEDCOM) has published an update to the recommendations for the medical management of avalanche victims, first released in 1996, in the renowned journal RESUSCITATION (Brugger H et al. Resuscitation. 1996 Feb;31(1):11-6. doi: 10.1016\/0300-9572(95)00913-2.). <\/p>\n\n
An 18-member expert team from North and South America, Japan, and Europe, led by Mathieu Pasquier, Lausanne, CH, and Hermann Brugger, Bruneck, ITA, reviewed the current literature using a scoping review and developed the new recommendations. The role of body temperature was given more weight compared to burial duration, as hypothermia can be outcome-relevant before cardiac arrest. In addition, the algorithm’s sequence was adapted to the actual clinical care workflow, improving its practical relevance. The article is freely accessible. <\/p>\n\n
Introduction: The International Commission for Mountain Emergency Medicine (ICAR MedCom) developed updated recommendations for the management of avalanche victims.<\/p>\n\n
Methods: ICAR MedCom created Population Intervention Comparator Outcome (PICO) questions and conducted a scoping review of the literature. We evaluated and graded the evidence using the American College of Chest Physicians system. <\/p>\n\n
Results: We included 120 studies including original data in the qualitative synthesis. There were 45 retrospective studies (38%), 44 case reports or case series (37%), and 18 prospective studies on volunteers (15%). The main cause of death from avalanche burial was asphyxia (range of all studies 65-100%). Trauma was the second most common cause of death (5-29%). Hypothermia accounted for few deaths (0-4%). <\/p>\n\n
Conclusions and recommendations: For a victim with a burial time \u2264 60 minutes without signs of life, presume asphyxia and provide rescue breaths as soon as possible, regardless of airway patency. For a victim with a burial time > 60 minutes, no signs of life but a patent airway or airway with unknown patency, presume that a primary hypothermic CA has occurred and initiate cardiopulmonary resuscitation (CPR) unless temperature can be measured to rule out hypothermic cardiac arrest. For a victim buried > 60 minutes without signs of life and with an obstructed airway, if core temperature cannot be measured, rescuers can presume asphyxia-induced CA, and should not initiate CPR. If core temperature can be measured, for a victim without signs of life, with a patent airway, and with a core temperature 30 \u00b0C attempt resuscitation, regardless of burial duration. <\/p>\n\n