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Abstract
Avalanche resuscitation will save lives if focussed on victims that have the potential
to survive. The purpose of this systematic review was to examine 4 critical prognostic
factors for burial victims in cardiac arrest.
Time of burial, airway patency, core temperature and serum potassium level were analyzed
as PICO (Patient/population, Intervention, Comparator, Outcome) questions within the
2010 Consensus on Science process of the International Liaison Committee on Resuscitation.
The electronic databases of Medline via PubMed, EMBASE via OVID and the Cochrane Database
of Systematic Reviews were searched using combinations of the search terms "avalanche",
"air pocket", "hypothermia" and "serum potassium".
Of 1910 publications that were identified 30 were found relevant. The predictive value
for survival of a short time of burial or a patent airway after 35 min of burial is
supported by 10 retrospective case-control studies, 4 case series and 2 experimental
studies, while no studies are neutral or opposed. A core temperature of less than
32 degrees C with a patent airway is supported by 2 retrospective case-control studies
and 3 case series, while 10 studies are neutral. Serum potassium level is supported
by 6 retrospective case-control studies and 3 case reports, while 3 retrospective
case-control studies and 1 animal model are neutral.
After 35 min of burial, or where the core temperature is less than 32 degrees C, a
patent airway is associated with survival to hospital discharge. A serum potassium
of less than 7 mmol/L may be a valuable indicator for survival when other indicators
are unclear. These findings should modify the current avalanche resuscitation scheme.
Copyright 2010 Elsevier Ireland Ltd. All rights reserved.