Background and objective Every year, between 100 and 250 people die in snow avalanches in Europe and North America. Rescue missions are dangerous and difficult, and resuscitation of avalanche victims often proves to be non-successful. European Resuscitation Council (ERC) guidelines for 2010 included specific advice concerning avalanche victims. In this student assignment I attempt to describe the pathophysiology and documentation for these guidelines, with special emphasis on time factors, presence of an air pocket and core temperature.
Methods This literature study is based on papers identified by a systematic search in Pubmed, Embase and Cochrane Library. Papers were also identified from citation lists in other publications, especially from the ILCOR (International Liaison Committee on Resuscitation) and ERC documents.
Results Asphyxia causes most avalanche deaths. Most victims suffer from acute asphyxia within 35 minutes, after that only a few survive, with an air pocket. Research on air pocket-physiology supports that long time survival is possible. There is no evidence that anyone has survived being completely buried for more than 35 minutes, or until their core temperature reaches 32, in the absence of an air pocket. If the victim has an air pocket and hypothermia precede the hypoxia, literature supports that survival is possible with aggressive rewarming, regardless of time and temperature.
Conclusion Literature does not prove the guidelines wrong. Nevertheless, the scientific basis for the guidelines are low quality evidence being based on statistics from retrospective studies, case reports and studies not directly related to the subject. Ethical considerations make prospective studies difficult. Still more research is vital.