Yvonnick Boué1, Jean-François Payen1, Julien Brun2, Sébastien Thomas2, Albrice Levrat3, Marc Blancher4, Guillaume Debaty4, Pierre Bouzat5. 1. 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. 2. Pole Anesthésie-Réanimation, Hôpital Michallon, Grenoble F-38043, France. 3. Service réanimation, Centre Hospitalier Région d'Annecy, Metz-Tessy, F-74370, France. 4. Service Urgences-SAMU-SMUR, Hopital Michallon, Grenoble F-38043, France. 5. 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.
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 43 min (25-76 min; 25-75th 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: 3.2 mmol/L (2.7-4.0) versus 5.6 mmol/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 favorable neurological outcome. Among criteria associated with survival, normal blood coagulation on admission warrants further investigation.
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 43 min (25-76 min; 25-75th 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: 3.2 mmol/L (2.7-4.0) versus 5.6 mmol/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 favorable neurological outcome. Among criteria associated with survival, normal blood coagulation on admission warrants further investigation.
Authors: Lars J Bjertnæs; Kristian Hindberg; Torvind O Næsheim; Evgeny V Suborov; Eirik Reierth; Mikhail Y Kirov; Konstantin M Lebedinskii; Torkjel Tveita Journal: Front Med (Lausanne) Date: 2021-05-13
Authors: Peter Paal; Les Gordon; Giacomo Strapazzon; Monika Brodmann Maeder; Gabriel Putzer; Beat Walpoth; Michael Wanscher; Doug Brown; Michael Holzer; Gregor Broessner; Hermann Brugger Journal: Scand J Trauma Resusc Emerg Med Date: 2016-09-15 Impact factor: 2.953
Authors: Marc Blancher; François Albasini; Fidel Elsensohn; Ken Zafren; Natalie Hölzl; Kyle McLaughlin; Albert R Wheeler; Steven Roy; Hermann Brugger; Mike Greene; Peter Paal Journal: High Alt Med Biol Date: 2018-02-15 Impact factor: 1.981
Authors: M Pasquier; M Blancher; S Buse; B Boussat; G Debaty; M Kirsch; M de Riedmatten; P Schoettker; T Annecke; P Bouzat Journal: Scand J Trauma Resusc Emerg Med Date: 2019-12-16 Impact factor: 2.953
Authors: Lars J Bjertnæs; Torvind O Næsheim; Eirik Reierth; Evgeny V Suborov; Mikhail Y Kirov; Konstantin M Lebedinskii; Torkjel Tveita Journal: Front Med (Lausanne) Date: 2022-02-23
Authors: Carsten Lott; Anatolij Truhlář; Anette Alfonzo; Alessandro Barelli; Violeta González-Salvado; Jochen Hinkelbein; Jerry P Nolan; Peter Paal; Gavin D Perkins; Karl-Christian Thies; Joyce Yeung; David A Zideman; Jasmeet Soar Journal: Notf Rett Med Date: 2021-06-10 Impact factor: 0.826