Termination of Cardiopulmonary Resuscitation in Mountain Rescue: A Scoping Review and ICAR MedCom 2023 Recommendations.

Lugnet, Viktor, Miles McDonough, Les Gordon, Mercedes Galindez, Nicolas Mena Reyes, Alison Sheets, Ken Zafren, and Peter Paal. Termination of cardiopulmonary resuscitation in mountain rescue: a scoping review and ICAR MedCom 2023 recommendations. High Alt Med Biol. 24:274-286, 2023. Background: In 2012, the International Commission for Mountain Emergency Medicine (ICAR MedCom) published recommendations for termination of cardiopulmonary resuscitation (CPR) in mountain rescue. New developments have necessitated an update. This is the 2023 update for termination of CPR in mountain rescue. Methods: For this scoping review, we searched the PubMed and Cochrane libraries, updated the recommendations, and obtained consensus approval within the writing group and the ICAR MedCom. Results: We screened a total of 9,102 articles, of which 120 articles met the inclusion criteria. We developed 17 recommendations graded according to the strength of recommendation and level of evidence. Conclusions: Most of the recommendations from 2012 are still valid. We made minor changes regarding the safety of rescuers and responses to primary or traumatic cardiac arrest. The criteria for termination of CPR remain unchanged. The principal changes include updated recommendations for mechanical chest compression, point of care ultrasound (POCUS), extracorporeal life support (ECLS) for hypothermia, the effects of water temperature in drowning, and the use of burial times in avalanche rescue.

Medical Care During Mountain Rescue in King County, Washington, from 2004 to 2017.

INTRODUCTION: Seattle Mountain Rescue (SMR) is a nonprofit, volunteer organization that provides mountain rescue services in King County, Washington. This study analyzed the medical care provided by SMR over 14 y to understand the challenges in patient care in the region and to perform data collection and monitoring. METHODS: A retrospective review of mission reports submitted from 2004 to 2017 was conducted. Date, location, demographics, activity, callout reason, chief complaint, treatments provided, extraction means, and helicopter utilization were analyzed. Data are presented as mean±SD, with range as appropriate, unless otherwise noted. Linear regression was used to estimate changes in mission volume over time. RESULTS: There were 552 missions involving 756 subjects during the study period. Mission totals increased by 4 (95% CI 2-6, P<0.001) per year. Four locations accounted for 38% of mission volume. Subject age was 36±18 y, and 59% of subjects were male. The most common activity leading to rescue was hiking (80%). Injuries or illness precipitated 58% of callouts, whereas lost, stranded, or overdue subjects comprised 40%. For subjects requiring medical treatment, 81% involved a traumatic injury, 64% were packaged in a litter, and 35% required splinting. CONCLUSIONS: The frequency of mountain rescue missions in King County, Washington, has increased in the past 14 y, with traumatic injuries most frequently requiring medical care. Missing data were common in most categories, and nonstandardized reports challenged research efforts. This study provides a baseline for future research and data collection and adds to the literature regarding the medical care provided during mountain rescue incidents.

Unattended Hoist Extraction of an Intubated Patient From Mountainous Terrain.

Airway management and maintenance of adequate ventilation during a patient's unattended helicopter rescue hoist extraction present unique challenges to the air medical provider. We present the case of a critically injured patient requiring emergent airway management and subsequent extrication via hoist from challenging, near-vertical terrain, which illustrates the logistical challenges of providing high-quality, neuroprotective mechanical ventilation in an austere air medical scenario.

Active learning increases student performance in science, engineering, and mathematics.

To test the hypothesis that lecturing maximizes learning and course performance, we metaanalyzed 225 studies that reported data on examination scores or failure rates when comparing student performance in undergraduate science, technology, engineering, and mathematics (STEM) courses under traditional lecturing versus active learning. The effect sizes indicate that on average, student performance on examinations and concept inventories increased by 0.47 SDs under active learning (n = 158 studies), and that the odds ratio for failing was 1.95 under traditional lecturing (n = 67 studies). These results indicate that average examination scores improved by about 6% in active learning sections, and that students in classes with traditional lecturing were 1.5 times more likely to fail than were students in classes with active learning. Heterogeneity analyses indicated that both results hold across the STEM disciplines, that active learning increases scores on concept inventories more than on course examinations, and that active learning appears effective across all class sizes--although the greatest effects are in small (n ≤ 50) classes. Trim and fill analyses and fail-safe n calculations suggest that the results are not due to publication bias. The results also appear robust to variation in the methodological rigor of the included studies, based on the quality of controls over student quality and instructor identity. This is the largest and most comprehensive metaanalysis of undergraduate STEM education published to date. The results raise questions about the continued use of traditional lecturing as a control in research studies, and support active learning as the preferred, empirically validated teaching practice in regular classrooms.