Quality of Cardiopulmonary Resuscitation in Avalanche Victims with a Single Rescuer: A Prospective, Crossover, Manikin Pilot Study.

Tanaka, Shota, Koshi Nakagawa, Yosuke Kanagawa, Takashi Katsurahara, Kazuki Kozakai, Ken Tsuhako, Fumitaka Yoshikawa, Soh Gotoh, Kensuke Osanai, Madoka Sono, Hironori Inoue, Shuji Sakanashi, Hiroyuki Takahashi, and Hideharu Tanaka. Quality of cardiopulmonary resuscitation in avalanche victims with a single rescuer: a prospective, crossover, manikin pilot study. High Alt Med Biol. 25:60-67, 2024. Background: Winter outdoor recreational activities such as off-piste skiing have gained popularity and, as a result, the number of avalanche-related deaths has increased. However, the quality of cardiopulmonary resuscitation (CPR) at avalanche sites remains unclear. Our study compared the quality of CPR performed in a simulated avalanche burial on a snowy mountain with that performed indoors. Methods: Ten prehospital health care providers participated in the crossover pilot study. Various methods, including over-the-head CPR (OTH-CPR) and standard CPR, were used to perform avalanche resuscitation, with five rescue breaths, followed by 30 chest compressions and two breaths. The quality CPR was judged by four variables of chest compression and ventilation. Results: The OTH-CPR performed indoors was better in quality: 5.33% [95% confidence interval (CI) -14.2 to 3.5] higher in adequate compression depth (94.3 ± 10.6% on the snow vs. 99.3 ± 1.1% indoors), 3.4% [95% CI -16.1 to 22.9] higher in adequate compression rate (70.4 ± 38.0% vs. 76.1 ± 35.7%), and 2.3% [95% CI -6.4 to 1.72] higher in adequate recoil (96.9 ± 4.8% vs. 99.2 ± 1.6%) than OTH-CPR on the snow. In terms of ventilation quality, OTH-CPR performed indoors had a 50% higher ventilation score [95% CI -73.0 to -27.0] than OTH-CPR on the snow (1.4 ± 4.3% vs. 45.9 ± 32.6%, Cohen's d = -1.81). Conclusions: Chest compression quality was slightly impaired in the avalanche scenarios on the snow than in indoor settings. Asphyxiation is the main cause of avalanche-related deaths; however, low ventilation quality was observed on snow compared with the indoor setting.

Computed tomography-based evaluation for normal adrenal gland size independent of body weight in dogs.

Background: Computed tomography (CT) is useful for evaluating the anatomical position of the adrenal gland and the presence of adrenal tumor (AT) metastasis or vascular invasion from ATs. Aim: To determine a weight-independent reference for adrenal gland size in normal dogs using CT. Methods: The medical records database of Gifu University was searched for data collected from April 2010 to December 2015 for records of dogs that underwent abdominal CT. The CT images were retrospectively analyzed using a Digital Imaging and Communications in Medicine viewer. The ratios of the minor axes of the adrenal glands to the height of the spinal cavity were investigated. Results: In total, 939 dogs were included. The left and right adrenal minor axes showed a moderate positive correlation with body weight (right: r = 0.61, p < 0.05; left: r = 0.54, p < 0.05). The L4 spinal cavity height showed a strong positive correlation with body weight (r = 0.82, p < 0.05). The left and right adrenal minor axis/L4 spinal cavity ratio did not correlate with body weight (right: r = 0.02, p = 0.53; left: r = -0.082, p < 0.05). The 95% confidence intervals of the adrenal minor axis/L4 spinal cavity ratios were as follows: right: 0.5-1.3 and left: 0.5-1.4. Conclusion: These results indicate that the adrenal minor axis/L4 spinal cavity ratio can be used as an index of adrenal gland size that is not affected by body weight. Patients in whom the adrenal minor axis/L4 spinal cavity ratio exceeds the upper limit (right 1.3, left 1.4) may have adrenal swelling.