Neurological outcome of cardiac arrest patients in mountain areas: An analysis of the Northern French Alps Emergency Network.

BACKGROUND: Mountainous areas pose a challenge for the out-of-hospital cardiac arrest (OHCA) chain of survival. Survival rates for OHCAs in mountainous areas may differ depending on the location. Increased survival has been observed compared to standard location when OHCA occurred on ski slopes. Limited data is available about OHCA in other mountainous areas. The objective was to compare the survival rates with a good neurological outcome of OHCAs occurring on ski slopes (On-S) and off the ski slopes (OffS) compared to other locations (OL). METHODS: Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2015 to 2021. The RENAU corresponding to an Emergency Medicine Network between all Emergency Medical Services and hospitals of 3 counties (Isère, Savoie, Haute-Savoie). The primary outcome was survival at 30 days with a Cerebral Performance Category scale (CPC) of 1 or 2 (1: Good Cerebral Performance, 2: Moderate Cerebral Disability). RESULTS: A total of 9589 OHCAs were included: 213 in the On-S group, 141 in the Off-S group, and 9235 in the OL group. Cardiac etiology was more common in On-S conditions (On-S: 68.9% vs OffS: 51.1% vs OL: 66.7%, p < 0.001), while Off-S cardiac arrests were more often due to traumatic circumstances (OffS: 39.7% vs On-S: 21.7% vs OL: 7.7%, p < 0.001). Automated external defibrillator (AED) use before rescuers' arrival was lower in the Off-S group than in the other two groups (On-S: 15.2% vs OL: 4.5% vs OffS: 3.7%; p < 0.002). The first AED shock was longer in the Off-S group (median time in minutes: OffS: 22.0 (9.5-35.5) vs On-S: 10.0 (3.0-19.5) vs OL: 16.0 (11.0-27.0), p = 0.03). In multivariate analysis, on-slope OHCA remained a positive factor for 30-day survival with a CPC score of 1 or 2 with a 1.96 adjusted odds ratio (95% confidence interval (CI), 1.02-3.75, p = 0.04), whereas off-slope OHCA had an 0.88 adjusted odds ratio (95% CI, 0.28-2.72, p = 0.82). CONCLUSIONS: OHCAs in ski-slopes conditions were associated with an improvement in neurological outcomes at 30 days, whereas off-slopes OHCAs were not. Ski-slopes rescue patrols are efficient in improving outcomes.

Effect of wet clothing removal on skin temperature in subjects exposed to cold and wrapped in a vapor barrier: a human, randomized, crossover field study.

BACKGROUND: Prehospital care for cold-stressed and hypothermic patients focuses on effective insulation and rewarming. When encountering patients wearing wet clothing, rescuers can either remove the wet clothing before isolating the patient or isolate the patient using a vapor barrier. Wet clothing removal increases skin exposure but avoids the need to heat the wet clothing during rewarming. Leaving wet clothing on will avoid skin exposure but is likely to increase heat loss during rewarming. This study aimed to evaluate the effect of wet clothing removal compared to containing the moisture using a vapor barrier on skin temperature in a prehospital setting. METHODS: This randomized crossover experimental field study was conducted in a snow cave in Hemsedal, Norway. After an initial cooling phase of 30 min while wearing wet clothes, the participants were subjected to one of two rewarming scenarios: (1) wet clothing removal and wrapping in a vapor barrier, insulating blankets, and windproof outer shell (dry group) or (2) wrapping in a vapor barrier, insulating blankets, and windproof outer shell (wet group). The mean skin temperature was the primary outcome whereas subjective scores for both thermal comfort and degree of shivering were secondary outcomes. Primary outcome data were analyzed using the analysis of covariance (ANCOVA). RESULTS: After an initial decrease in temperature during the exposure phase, the dry group had a higher mean skin temperature compared to the wet group after only 2 min. The skin-rewarming rate was highest in the initial rewarming stages for both groups, but increased in the dry group as compared to the wet group in the first 10 min. Return to baseline temperature occurred significantly faster in the dry group (mean 12.5 min [dry] vs. 28.1 min [wet]). No intergroup differences in the subjective thermal comfort or shivering were observed. CONCLUSION: Removal of wet clothing in combination with a vapor barrier increases skin rewarming rate compared to encasing the wet clothing in a vapor barrier, in mild cold and environments without wind. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT05996757, retrospectively registered 18/08/2023.

Surviving 20 Hours of Critical Avalanche Burial and a Core Temperature of 22.5 °C.

A 24-year-old male snowboarder was buried in an avalanche for 20 h and rescued on the next day at a depth of 2.3 m below the snow surface. A large air pocket was noted in front of his mouth and nose. He was responsive but moved restlessly and uncoordinatedly. The epitympanic temperature was 22.5 °C. He was bradycardic (35/min), and a right bundle branch block with Osborn waves was noted. Rewarming (1 °C/h) was initiated with continuous hemodialysis; core temperature raised to 29.8 °C within 4 h. At 30 °C he became conscious. With rewarming, the heart rate increased to 90 beats per minute and the ECG changes disappeared; nonfreezing cold injuries were noted. On the next day, his pulmonary function deteriorated-fluid overload of 9 L since admission was diagnosed. With spontaneous diuresis, the situation improved. On Day 4, the neurologist reported subtle polyneuropathy in both legs secondary to hypothermia, without tendency to regress. This case occurred more than 20 years ago but has not been reported yet. To this day, this is the third-longest critical avalanche burial ever reported. We discuss the circumstances of this accident, the clinical course, and how treatment has changed since 2000.

Rock Climber Self-Rescue Skills.

INTRODUCTION: Rock climbing involves some inherent danger, and rock climbers should be able to carry out basic rescue techniques for their own safety. This study seeks to assess such abilities by examining self-rescue skills in a cohort of rock climbers. METHODS: Climbers who participate in multipitch sport or traditional climbing styles were recruited via posters at a local climbing gym and on social media. Participants completed a survey assessing climbing history and confidence in their rescue skills and then were evaluated on 3 rescue scenarios in an indoor, standardized setting. Scenario pass rates were calculated and compared with rescue skill confidence on the survey. RESULTS: Twenty-five climbers participated in the study. Mean confidence in rescue skills varied from 4 to 4.5 (on a 7-point scale). The pass rates for the 3 scenarios were 28%, 68%, and 52%. Only 24% of climbers passed all 3 scenarios. Surveyed confidence in rescue skills and pass rate statistically correlated in only 1 scenario. CONCLUSIONS: Self-rescue skills were generally lacking in our study population. Climber confidence, experience, training, and climbing frequency did not appear to be associated with a higher level of rescue skills. Self-rescue skills should be emphasized in climbing instruction and courses to increase overall safety.

Patient-centred mountain medicine.

Venturing into the mountains, doctors have accompanied expeditions to provide routine care to the teams, undertake research and occasionally take on a rescue role. The role of doctors practicing mountain medicine is evolving. Public health issues involving concepts of health and safety have become necessary with the coming of commercial and youth expeditions. Increasingly individuals with a disability or a medical diagnosis choose to ascend to high altitudes. Doctors become involved in assessment of risk and providing advice for such individuals. The field of mountain medicine is perhaps unique in that acceptance of risk is part of the ethos of climbing and adventure. The pursuit of mountaineering goals may represent the ultimate conquest of a disability. Knowledge of mountain environment is essential in facilitating mountain ascents for those who choose to undertake them, in spite of a disability or medical condition.

Body Positioning of Buried Avalanche Victims.

OBJECTIVE: The immediate medical management of buried avalanche victims will to some extent be dictated by the victim's body positioning in the snow. Medical personnel are trained to assess and manage victims in a supine body position. Furthermore, avalanche first responders are trained to handle extricated avalanche victims carefully out of concerns for causing hemodynamic instability or for aggravating spinal injury. Thus, locating and extricating avalanche victims in positions other than supine has the potential to complicate immediate medical management. To our knowledge, the current medical literature does not detail the body positioning of buried victims. METHODS: In order to ascertain the most common body positioning of buried avalanche victims we reviewed the avalanche incident database of the Colorado Avalanche Information Center (CAIC). This comprehensive database strives to track over 160 fields of information for each avalanche victim, including the body and head positioning of buried victims. RESULTS: Head positioning was recorded for 159 buried victims. We found that 65% of buried avalanche victims were found with their heads in a downhill position, 23% with their heads uphill and 11% with their heads in the same level as the rest of their bodies. Body positioning was recorded in 253 victims. 45% of victims were found lying prone, 24% supine, 16% were sitting or standing and 15% were found lying on their sides. We identified 135 victims where both head and body position was registered. 40% of victims were found prone with their heads in a downhill position CONCLUSIONS: The majority of victims will be extricated with their heads in a downhill position. Moreover, almost half of victims will be found prone. We believe this will have significant impact on the immediate medical management. We believe current training in avalanche medical rescue should emphasize managing victims in non-supine positions. Finally, our findings may represent another benefit of modern extrication techniques.

Effect of advanced trauma life support (ATLS) on the time needed for treatment in simulated mountain medicine emergencies.

OBJECTIVE: The number of tourists exploring mountainous areas continues to increase. As a consequence, rescue operations are increasing, especially for trauma and polytrauma victims. The outcome of such patients depends greatly on the duration of the prehospital stabilization. Limited medical training of mountain rescuers may adversely affect the outcome of patients. There is no study investigating high altitude trauma treatment. The aim of this study is to analyze the impact of advanced trauma life support (ATLS) principles in mountain trauma, and to discuss a possible role of ATLS in mountain medicine education programs. METHODS: We designed 5 tasks representing life-threatening trauma problems encountered in mountain rescue. They were used to evaluate the physician's ability to adequately diagnose and react to trauma situations. We created 2 groups: 1) the ATLS group, consisting of physicians who passed the ATLS course and the mountain medicine course, and 2) the non-ATLS group, consisting of physicians who did not obtain the ATLS training but who did pass the mountain medicine course. We compared the time spent to complete the tasks in both groups. RESULTS: In 4 of the 5 tasks (airway, breathing, circulation, and combination), the ATLS group completed the task significantly faster. In the environment task, however, the ATLS group was slower. This was the only not significant result. CONCLUSIONS: ATLS principles adapted and implemented for high altitude medicine education may have a positive impact on high altitude trauma treatment and outcomes.

An observational study of personal ultraviolet dosimetry and acute diffuse reflectance skin changes at extreme altitude.

OBJECTIVE: To determine the level of UV radiation at extreme altitude and to assess the effect it has on the skin. METHODS: Fifteen expeditioners and 10 Sherpas were assessed during a climbing expedition on the north side of Mt Everest (8848 m). UV exposure measurement and diffuse skin reflectance spectrophotometry were performed at the beginning and end of the expedition. RESULTS: Over the course of the expedition, the expeditioners and Sherpas received a median dose of 93.6 (interquartile range [IQR], 61.0-102.8) and 102.5 (IQR, 72.2-117.8) minimal erythemal doses (MEDs) of UV radiation. The maximum dosage exceeded 106 ± 1.4 MEDs. Using reflectance spectrophotometry, expeditioner and Sherpa melanin-hemoglobin increased by 83.6% (IQR, -1.5 to 89.8%) and 24.7% (IQR, -22.4 to 61.5%) for exposed skin, respectively. The amount of subcutaneous lipid-water decreased by a factor of 196.6 (IQR, 52.1-308.4) and 46.7 (IQR, 1.8-1156.5), for expeditioners and Sherpas, respectively. CONCLUSIONS: This expedition's participants received massive doses of UV radiation during their time at high altitude. In many individuals this was similar to the annual exposure of northern European office-workers (100 MEDs). Diffuse skin reflectance spectroscopy revealed considerable subcutaneous lipid loss, skin dehydration, and increased melanin in keeping with these levels of exposure.

Lessons Learned from the COVID-19 Vaccination Campaigns in Veneto Region: Population Vaccination Centers as Support for the Traditional Outpatient Model.

The extraordinary vaccination campaigns of the COVID-19 pandemic era put organizational and operational systems to the test in numerous territorial contexts. In the Veneto region, the activation of population vaccination centers (CVPs) guaranteed the provision of vaccines to mountain areas. These centers, drive-in and building-based, improved the efficiency of dose administration in relation to similar conditions where healthcare workers (HCWs) were routinely involved in clinics. Overall, a comparison of the two models investigated, with the same numbers of HCWs involved and the same opening hours for the vaccination sites, has shown that the CVPs are able to guarantee three times as many vaccines administered, compared with the traditional outpatient model. This study aims to provide a detailed analysis of the adopted organizational model, highlighting the best practices and improvements required to guarantee a timely and effective public health response, and evaluating the opportunities to deploy these innovative methods actively in a standard context.

Effectiveness and use of avalanche airbags in mortality reduction among winter-recreationists.

BACKGROUND/OBJECTIVE: The number of backcountry skiers and snowboarder surged in the last years, especially during the COVID-19 pandemic, as ski resorts shut down. Inevitably, this led to an increase in avalanche-related injuries and death. As avalanche rescue device, avalanche airbags are increasingly becoming part of the standard winter mountaineering equipment. This study provides a review of the available data and an updated perspective on avalanche airbags, discussing their function and efficacy to reduce mortality and their limitations. RESULTS: Causes of death in individuals caught by avalanches are multiple. Airbags seem to reduce mortality by decreasing the chances of critical burial, the most determining risk factor. However, there is a scarcity of reliable scientific research on the topic, and the way in which airbags reduce mortality and to what extent is still debated. Several elements seem to influence airbags efficacy, and their use still yields several limitations linked to manufacturing, proper use, users education and risk compensation. CONCLUSIONS: Avalanche airbags seem to be an important tool in reducing mortality in the backcountry expeditions. However, more research and standardized data collection are needed to fill the knowledge gap, and mountain communities should promote adequate education of winter-recreationists on how to prevent and react to an avalanche and on the correct use of airbags in combination with already available tools such as transceivers, probes and shovels; and manufacturing companies should ensure higher efficacy of the survival avalanche equipment for better prevention of burial, asphyxia and trauma.

Influence of high altitude after a prior ascent on physical exhaustion during cardiopulmonary resuscitation: a randomised crossover alpine field experiment.

BACKGROUND: Performing cardiopulmonary resuscitation (CPR) inevitably causes significant physical, as well as psychological stress for rescuers. Physical activity at high altitude, a hypobaric and hypoxic environment, similarly adds to the level of stress and causes multiple physiological changes. Continuous measurement of pulse rate serves as an objective measure of fatigue during CPR. We therefore aimed to investigate rescuers' heart rates as a measure of physical strain during CPR in a high-altitude alpine environment to provide a better understanding of the physiological changes under these very special conditions. METHODS: Twenty experienced mountaineers performed basic life support (BLS) on a manikin for 16 min, both at baseline altitude and at high altitude (3454 m) following a quick and exhausting ascent over 1200 m. Sequence of scenarios was randomised for analysis. Heart rate was continuously measured and compared between baseline and high altitude by absolute differences and robust confidence intervals. RESULTS: During CPR at baseline, the average heart rate increased from 87 bpm (SD 16 bpm) to 104 bpm [increase 17 bpm (95% CI 8.24-24.76)], compared to an increase from 119 bpm (SD 12 bpm) to 124 bpm [increase 5 bpm (95% CI - 1.59 to 12.19)] at high altitude [difference between two groups 32 bpm (95% CI 25-39)]. Differences between periods of chest compressions and ventilations were very similar at baseline [19 bpm (95%CI 16.98-20.27)] and at high altitude [20 bpm 95% CI 18.56-21.44)], despite starting from a much higher level at high altitude. The average heart rates of rescuers at high altitude at any point were higher than those at baseline at any other point. CONCLUSION: Performing BLS CPR causes exhaustion both at base level and at a high altitude. A further increase during CPR might imply a physiological reserve for adapting to additional physical exertion at high altitude. Phases of ventilation are much needed recovery-periods, but heart rates remain very high. Subjective measures of exhaustion, such as the BORG-scale, might lead to rescuers' overestimation of their own performance.

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.

Frostbite treatment: a systematic review with meta-analyses.

INTRODUCTION: Our objective was to perform a systematic review of the outcomes of various frostbite treatments to determine which treatments are effective. We also planned to perform meta-analyses of the outcomes of individual treatments for which suitable data were available. MAIN BODY: We performed a systematic review and meta-analyses in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched PubMed, Cochrane Trials, and EMBase to identify primary references from January 1, 1900, to June 18, 2022. After eliminating duplicates, we screened abstracts to identify eligible studies containing information on treatment and outcomes of Grade 2 to 4 frostbite. We performed meta-analyses of groups of articles that provided sufficient data. We registered our review in the prospective registry of systematic reviews PROSPERO (Nr. 293,693). We identified 4,835 potentially relevant studies. We excluded 4,610 studies after abstract screening. We evaluated the full text of the remaining 225 studies, excluding 154. Ultimately, we included 71 articles with 978 cases of frostbite originating from 1 randomized controlled trial, 20 cohort studies and 51 case reports. We found wide variations in classifications of treatments and outcomes. The two meta-analyses we performed both found that patients treated with thrombolytics within 24 h had better outcomes than patients treated with other modalities. The one randomized controlled trial found that the prostacyclin analog iloprost was beneficial in severe frostbite if administered within 48 h. CONCLUSIONS: Iloprost and thrombolysis may be beneficial for treating frostbite. The effectiveness of other commonly used treatments has not been validated. More prospective data from clinical trials or an international registry may help to inform optimal treatment.

Crevasse accidents in the Swiss Alps Epidemiology and mortality of 405 victims of crevasse accidents from 2010 to 2020.

INTRODUCTION: The clinical spectrum of injuries in crevasse accidents can range from benign to life-threatening, even including death. To date, little is known about incidence and causes. METHODS: We retrospectively analyzed mountain rescue missions that included crevasse accidents and took place in Switzerland from 2010 to 2020. Demographic and epidemiological data were collected. Injury severity was graded according to the National Advisory Committee for Aeronautics (NACA) score. Winter season was defined as December to May, and summer season as June to November. RESULTS: A total of 321 victims of crevasse falls were included in the study. The median age of victims was 41.2 years (interqauartile range [IQR] 31.3 to 51.6), with 82% (n=260) being male and 59% (n=186) foreigners. The typical altitude range at which rescue missions were performed was between 3000 and 3499m (44% of all cases). The median depth of the fall was 15 meters (IQR 8 to 20) during the winter season compared to 8 meters (IQR 5 to 10) during the summer, p<0.001. Overall mortality was 6.5%. The NACA score was ≥4 for 9.4% (n=30) of the victims. 55% (n=177) had a NACA score of 0 or 1. There was a significant positive correlation between the depth of fall and the injury severity (Pearson`s correlation r=0.35, 95%- confidence interval: 0.18 to 0.51), p<0.001. CONCLUSION: More than half of victims fallen into a crevasse are uninjured or sustain mild injury. Life-threathening injuries were found in about 10% of victims and the crevasse fall was fatal in 6.5% of cases. Injury severity positively correlates with the depth of fall, which is higher during winter season.

Successful Pre-Rewarming Resuscitation after Cardiac Arrest in Severe Hypothermia: A Retrospective Cohort Study from the International Hypothermia Registry.

The aim of our study is to investigate successful pre-rewarming resuscitation after hypothermic cardiac arrest (HCA). The hypothermic heart may be insensitive to defibrillation when core temperature is below 30 °C and after successful defibrillation, sinus rhythm often returns into ventricular fibrillation. Recurrent defibrillation attempts may induce myocardial injury. Discrepancy exists concerning pre-rewarming defibrillation between the guidelines of the European Resuscitation Council and American Heart Association. The International Hypothermia Registry (IHR) gathers hypothermia cases. The primary outcome was survival. Secondary outcomes were the characteristics of defibrillation, the effect of Adrenaline administration under 30 °C, and the duration of CPR. Of the 239 patients, eighty-eight were in cardiac arrest at arrival of the rescue team. Successful pre-rewarming resuscitation was obtained in 14 patients. The outcome showed: seven deaths, one vegetative state, two patients with reversible damage, and four patients with full recovery. A total of five patients had a shockable rhythm, and defibrillation was successful in four patients. The response rate to Adrenaline was reported as normal in six patients. There were no statistically significant differences in the presence of a shockable rhythm, the success of defibrillation, and the effect on Adrenaline administration between the survivors and non-survivors. Successful resuscitation in severe hypothermia is possible before active rewarming and arrival in the hospital, thus improving the chance of survival.

Diploma in Mountain Medicine: A Perspective of a Female Doctor from Nepal.

Poudel, Sangeeta. Diploma in mountain medicine: a perspective of a female doctor from Nepal. High Alt Med Biol. 22:417-419, 2021.-Mountaineering is an alluring recreation receiving increasing global attention. With increasing adventure activities in the mountain, the risk of mishaps is high. Each year many trekkers, athletes, pilgrims, and porters are significantly affected and some even lose their lives due to a lack of knowledge in identification and management of altitude illness and other traumatic injuries. The diploma in mountain medicine (DiMM) trains participants in high-altitude environments to access area safety, diagnose, treat, and evacuate victims using available resources, improvised techniques, and rope skills. Doctors willing to work in the wilderness have to work in austere medical clinics, participate in search and rescues, volunteer at sporting events, or work on an expedition often being the only available doctor. Despite challenges, mountain doctors work in the wilderness as a hobby and some make a career of it, as in certain countries mountain medicine is now recognized as a subspeciality. As it becomes more accessible, the mountain medicine course is becoming increasingly popular, with the course in Nepal being no exception. It is developed as a specialty in developed countries, whereas in developing countries it will soon reach maturity. This is a personal report of a young female doctor taking part in a DiMM course in 2019 from Nepal.

Influence of physical strain at high altitude on the quality of cardiopulmonary resuscitation.

BACKGROUND: High quality cardiopulmonary resuscitation is a key factor in survival with good overall quality of life after out-of-hospital cardiac arrest. Current evidence is predominantly based on studies conducted at low altitude, and do not take into account the special circumstances of alpine rescue missions. We therefore aimed to investigate the influence of physical strain at high altitude on the quality of cardiopulmonary resuscitation. METHODS: Alpine field study. Twenty experienced mountaineers of the Austrian Mountain Rescue Service trained in Basic Life Support (BLS) performed BLS on a manikin in groups of two for 16 min. The scenario was executed at baseline altitude and immediately after a quick ascent over an altitude difference of 1200 m at 3454 m above sea level. The sequence of scenarios was randomised for a cross over analysis. Quality of CPR and exhaustion of participants (vital signs, Borg-Scale, Nine hole peg test) were measured and compared between high altitude and baseline using random-effects linear regression models. RESULTS: The primary outcome of chest compression depth significantly decreased at high altitude compared to baseline by 1 cm (95% CI 0.5 to 1.3 cm, p < 0.01). There was a significant reduction in the proportion of chest compressions in the target depth (at least 5 cm pressure depth) by 55% (95% CI 29 to 82%, p < 0.01) and in the duration of the release phase by 75 ms (95% CI 48 to 101 ms, p < 0.01). No significant difference was found regarding hands-off times, compression frequency or exhaustion. CONCLUSION: Physical strain during a realistic alpine rescue mission scenario at high altitude led to a significant reduction in quality of resuscitation. Resuscitation guidelines developed at sea level are not directly applicable in the mountain terrain.

Sudden Cardiac Arrest and Cardiopulmonary Resuscitation with Automated External Defibrillator in the Austrian Mountains: A Retrospective Study.

Background: Few data exist on the likelihood of surviving sudden cardiac arrest in the mountains. The aim of this study was to analyze the epidemiology and outcomes of patients suffering sudden cardiac arrest and undergoing cardiopulmonary resuscitation (CPR) with automated external defibrillator (AED) in the Austrian mountains. Materials and Methods: We analyzed all cardiac arrest cases in the Austrian mountains reported in the nationwide Austrian Alpine Police database from October 26, 2005, to December 31, 2015. To obtain information on outcomes, these patient data were manually merged with patient data from the main Austrian referral center for mountain emergencies, Innsbruck Medical University Hospital. Results: Overall, 781 cases of sudden cardiac arrest in the Austrian mountains were recorded. In 136 cases (17%), CPR with AED was attempted. The most frequent activities at the time of sudden cardiac arrest were hiking (n = 63, 46%) and skiing or snowboarding (n = 44, 32%). In the nationwide Austrian Alpine Police database, only 4 (3%) patients survived, whereas in the Innsbruck Medical University Hospital database, there were seven survivors who received CPR and AED. All survivors had received immediate CPR with an AED. Five patients had good neurological outcome (cerebral performance category 1-2). Conclusions: In the Austrian mountains, CPR was attempted in less than 20% of sudden cardiac arrest cases. The few that survived had received immediate CPR with an AED. To better understand the circumstances and outcome of sudden cardiac arrest in the mountains, out-of hospital and in-hospital data should be linked.

[Nontraumatic medical emergencies in mountain rescues]. / Utilidad de la ecografi ́a en urgencias: el protocolo RUSH.

OBJECTIVES: To describe the clinical and epidemiologic characteristics of patients with nontraumatic medical problems rescued by a Spanish mountain emergency response service (061 Aragon). MATERIAL AND METHODS: Retrospective observational analysis of records of mountain rescues completed between July 2010 and December 2016. RESULTS: A total of 164 patients with nontraumatic medical emergencies were rescued; 82.3% were males. Most patients were between the ages of 50 and 59 years. Environmentally related problems, most often hypothermia, accounted for 36.6% of the emergencies. Cardiac problems led to 20.7% and digestive problems to 12.8%. Eighty-two percent of the patients were hiking or engaged in general mountain activities (other than rock climbing, canyoning, hunting, or skiing). CONCLUSION: Recent years have seen a rise in the number of patients requiring rescue from mountains for nontraumatic medical emergencies, particularly heart problems. The typical patient to expect would be a man between the ages of 50 and 59 years who is hiking in the summer.

OBJETIVO: Describir las características clínico-epidemiológicas de los pacientes rescatados por la unidad de rescate de montaña del 061 de Aragón que presentaron patologías médicas no traumáticas. METODO: Estudio observacional retrospectivo de los rescates de montaña realizados entre julio de 2010 y diciembre de 2016. RESULTADOS: Se analizaron 164 pacientes con patología médica de origen no traumático durante el rescate (82,3% varones). El intervalo de edad más frecuente fue de 50 a 59 años. El 36,6% presentaban patologías relacionadas con el medio, siendo la hipotermia la más frecuente. El 20,7% fue patología cardiaca y el 12,8% fueron problemas digestivos. La actividad practicada por los pacientes fue el senderismo/montañismo en un 82% de las ocasiones. CONCLUSIONES: Se observa un aumento del número de pacientes rescatados con patología médica no traumática en los últimos años, y destaca el aumento de problemas cardiacos. El paciente tipo esperable sería un varón de entre 50 y 59 años practicando senderismo en época estival.