Management and outcome of patients with cardiac arrest after avalanche accidents in the Swiss Alps: A retrospective analysis.

Aim
Our aim is to evaluate the management and outcome of avalanche victims in cardiac arrest (CA), focusing on the adherence to international management guidelines and to identify ways to improve the future care of avalanche victims through retrospective evaluation of the missions.Methods
We analysed a retrospective cohort of all avalanche victims in CA treated by Swiss Air-Rescue Rega between 2010 and 2024. Data regarding the avalanche burial (type of burial, burial duration, presence of a patent airway) were evaluated, as were helicopter operational data, data on prehospital medical care [cardiopulmonary resuscitation (CPR) efforts, airway management, core temperature], transport destination, data from further in-hospital treatment if applicable [core temperature, type of rewarming, serum potassium levels, extracorporeal life support (ECLS)] as well as patient outcome.Results
147 patients could be evaluated. 50 (34%) were declared dead without CPR efforts. CPR was started in 97 patients (66%), of whom 19 achieved ROSC (13%). Only 4 of these patients survived to hospital discharge (3%), 3 of whom had a good neurological outcome (2%). 34 patients (23%) were transported to hospital while CPR was ongoing, of whom in 11 (7%) ECLS was tried to initiate. None of these patients survived to hospital discharge. 27 patients (18%) were not treated in accordance with the guidelines. 22 of these (15%) were (potentially) undertreated (mainly in the sense of transport to a non-ECLS centre, although an ECLS centre would have been correct), 5 (3%) were overtreated (mainly in the sense of transport under ongoing CPR, although not indicated). 61% were tracheally intubated. On admission, core temperature was 1.9 °C (95% confidence interval 1.1-2.7) lower than the temperature measured on scene.Conclusions
Patients who suffer a CA in avalanche accidents have a very poor outcome. A high proportion of patients were not tracheally intubated during transport, cooled down further during resuscitation and transport or were not transported to ECLS centres although indicated. On the other hand, the outcome of ECLS patients is extremely poor.