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

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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

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

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

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

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

e8 Letter to the Editor / Resuscitation 91 (2015) e7–e8

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

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

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

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

j.resuscitation.2015.03.009. International Commission for Mountain Emergency

Medicine ICAR MEDCOM, Italy References a,b John Ellerton

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-

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

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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

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