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The Avalanche Victim Resuscitation Checklist, a Victims with Out-Of-Hospital Cardiac Arrest (OHCA) in the Period

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The Avalanche Victim Resuscitation Checklist, a Victims with Out-Of-Hospital Cardiac Arrest (OHCA) in the Period The Avalanche Victim Resuscitation Checklist MED-REC0033 / Alpine Medicine Commission / December 31, 2014 1/3 Resuscitation 91 (2015) e7–e8 Contents lists available at ScienceDirect Resuscitation j ournal homepage: www.elsevier.com/locate/resuscitation Letter to the Editor The Avalanche Victim Resuscitation Checklist, a victims with out-of-hospital cardiac arrest (OHCA) in the period 4 new concept for the management of avalanche 1987–2009. Data of key parameters were incomplete, overall victims survival was very low, and initiation of CPR was lower than expected for patients with long burials and patent airways. The Sir, reasons to initiate or withhold resuscitation remained unclear in the majority of cases. Deficiencies in awareness of the guidelines The International Commission for Mountain Emergency by bystanders, first responders and hospital personnel, and the Medicine (ICAR MEDCOM) established official consensus guidelines transfer of essential information from the accident site to hospital 1 on the onsite treatment of avalanche victims in 2002 and 2013. may have been partially responsible for the poor outcome. These aim to inform basic and advanced life support providers of the Although existing management guidelines are simple, utiliz- best evidence-based management, as selected severely hypother- ing the theoretical knowledge and making the right decisions can mic victims in cardiac arrest can survive with a good neurologic be very challenging in the stressful environment of an avalanche 2 outcome even after several hours of burial. Key parameters for where major decisions, such as starting or withholding resusci- an avalanche victim in cardiac arrest are duration of burial, airway tation, are being taken. Furthermore, it is to be expected that as 3 patency, core temperature and the initial ECG rhythm. the number of victims in the avalanche increases the more diffi- However a recent study in the European Alps showed poor cult it is to maintain adherence to guidelines both for BLS and ALS adherence with the ICAR MEDCOM guidelines for avalanche providers. Information collection and onward flow to the hospital Fig. 1. Avalanche Victim Resuscitation Checklist. The white section is addressed to a basic life support trained first responder, the red section to an advanced life support trained health care provider. Patient ID = patient identity; CPR = cardiopulmonary resuscitation; ALS = Advanced Life Support; ECLS = extracorporeal life support (cardiopulmonary bypass/extracorporeal membrane oxygenation). * Time between burial and uncovering the face; ** if duration of burial is unknown, core temperature may be substituted using esophageal or epitympanic (thermistor-based sensor) temperature; *** patients who present with cardiac instability (ventricular arrhythmias, systolic blood pressure ◦ + −1 <90 mmHg) or core temperature <28 C should be transported towards hospital with ECLS rewarming possibility; **** if K at hospital admission exceeds 12 mmol L consider + −1 stopping resuscitation (after excluding crush injuries an consideration of the use of depolarising paralytics); in an adult with K = 8–12 mmol L and other factors consistent with non-survival, termination of resuscitation should be considered. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.) http://dx.doi.org/10.1016/j.resuscitation.2015.03.009 0300-9572/© 2015 Elsevier Ireland Ltd. All rights reserved. e8 Letter to the Editor / Resuscitation 91 (2015) e7–e8 d are also likely to deteriorate as, in Crew Resource Terms, ‘chaos’ International Commission for Mountain Emergency replaces ‘order’. This is especially true in a mass casualty incident. Medicine ICAR MEDCOM, Switzerland The checklist concept has been promoted by the World Health a,b,c Marc Blancher Organization since 2008, and has received much attention due a 5 Emergency Department, University Hospital of to its potential to improve quality of patient care. We used this Grenoble, boulevard de la chantourne, BP 217, 38043 concept to create an Avalanche Victim Resuscitation Checklist Grenoble Cedex 9, France (Figs. 1, S1 and S2). It is based on the best available evidence and b 3,4 French Mountain Rescue Association ANMSM, the standards required of medical checklists. Together with stan- France dardized teaching material, the checklist was approved by the ICAR c International Commission for Mountain Emergency MEDCOM in 2013. It is a practical tool, designed to improve adher- Medicine ICAR MEDCOM, France ence to guidelines and the transfer of information from accident site to and through the hospital phases. The correct use of the checklist Thierry Spichiger is described in the supplementary file (S3), an AudioSlide pre- Swiss Air Ambulance Rega, Swiss Alpine Rescue, P.O. sentation and a teaching presentation (LINK). The working group Box 1414, CH-8058 Zurich Airport, Switzerland emphasizes that classroom training and simulations in the field Fidel Elsensohn by organized rescue teams are fundamental for the correct and International Commission for Mountain Emergency efficient use. Medicine ICAR MEDCOM, Schloesslestrasse 36, As a new concept for the management of avalanche victims, we Roethis A-6832, Austria plan to do validation studies to assess its impact on survival and on a,b appropriate resuscitation decisions including reducing futile resus- Dominique Létang a citation attempts. Data collected will be available for further studies Association Nationale pour l’Étude de la Neige et des on management of avalanche victims. Avalanches ANENA, 15, rue Ernest Calvat, Grenoble F-38000, France b Conflict of interest statement ICAR Avalanche Commission, France a,b,c Jeff Boyd All authors declare no financial or personal conflict of interest. a International Commission for Mountain Emergency Medicine ICAR MEDCOM, Canada Acknowledgments b International Federation of Mountain Guides, Switzerland To all ICAR MEDCOM members who participated in the project c Department of Emergency Medicine, Mineral and to Emily Procter for editing. Springs Hospital, Box 400, Bow Avenue, Banff, AB T1L 1A5, Canada Appendix A. Supplementary data a,b Giacomo Strapazzon a Supplementary data associated with this article can be EURAC Institute of Mountain Emergency Medicine, found, in the online version, at http://dx.doi.org/10.1016/ Drususallee 1, I-39100 Bozen/Bolzano, Italy b j.resuscitation.2015.03.009. International Commission for Mountain Emergency Medicine ICAR MEDCOM, Italy References a,b John Ellerton a International Commission for Mountain Emergency 1. Brugger H, Durrer B, Elsensohn F, et al. Resuscitation of avalanche victims: Medicine ICAR MEDCOM, United Kingdom evidence-based guidelines of the international commission for mountain emer- b gency medicine (ICAR MEDCOM): intended for physicians and other advanced life Birbeck Medical Group, Penrith, Cumbria CA10 3AZ, support personnel. Resuscitation 2013;84:539–46. United Kingdom 2. Boué Y, Payen JF, Torres JP, Blancher M, Bouzat P. Full neurologic recovery after a,b prolonged avalanche burial and cardiac arrest. High Alt Med Biol 2014;15:522–3. Hermann Brugger 3. Boyd J, Brugger H, Shuster M. Prognostic factors in avalanche resuscitation: a a EURAC Institute of Mountain Emergency Medicine, systematic review. Resuscitation 2010;81:645–52. 4. Strapazzon G, Plankensteiner J, Mair P, Ruttmann E, Brugger H. Triage and survival Drususallee 1, Bozen/Bolzano I-39100, Italy b of avalanche victims with out-of-hospital cardiac arrest in Austria between 1987 International Commission for Mountain Emergency and 2009. Resuscitation 2012;83:e81. Medicine ICAR MEDCOM, Italy 5. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce mor- bidity and mortality in a global population. N Engl J Med 2009;360:491–9. ∗ Corresponding author at: Rega, Swiss Air , , , ,∗ a b c d Ambulance, Departement Medizin, P.O. Box 1414, Alexandre Kottmann a CH-8058 Zurich Airport, Switzerland. Swiss Air Ambulance Rega, P.O. Box 1414, CH-8058 E-mail address: [email protected] (A. Zurich Airport, Switzerland b Kottmann) Department of Intensive Care Medicine, Inselspital, Bern University Hospital, Switzerland c 31 December 2014 Swiss Society for Mountain Medicine, Switzerland.
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