AVALANCHE INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 456

facility. If the person is hypothermic but has a core body temperature greater than 86°F
(30°C), the standard CPR/advanced cardiac life support (ACLS) protocol should be fol-
lowed for at least twenty minutes.
Unfortunately, the probability of successful resuscitation of a person buried in an ava-
lanche who is in cardiac arrest at the time of extrication is generally poor and depends on
whetherthearrestoccurredfromasphyxiationorfromhypothermia.Forburialsoflessthan
one hour when the core temperature is greater than 86°F (30°C), resuscitation is unlikely
to be successful because death probably has resulted from asphyxiation or lethal trauma.
Persons extricated from avalanche burials of greater than one hour who have no signs of
lifebutwhoareseverely hypothermic—a coretemperature lessthan86°F(30°C)—andfor
whom an air pocket for breathing was detected upon extrication, may be considered for
transport to a medical facility with the capability for rapid extracorporeal blood rewarming
( Fig. 30-2 ) .
Determining whether an air pocket for breathing has been present as a person buried
by an avalanche is extricated is essential, can be challengingø, and is often impossible, in
which case an air pocket should be assumed to have been present.
Most individuals buried in avalanches and extricated in cardiac arrest, however, have
died from asphyxiation. Continuing resuscitation efforts until rewarming occurs for such
personsisunlikelytoresultinsurvival,particularlyifnoairpocketispresentoriftheupper
airwayisobstructedbysnow.Inonestudyofthirteenindividualsburiedbyavalanchesand
found in cardiac arrest after 30 to 165 minutes, none survived after resuscitation efforts,
suggesting that cardiac arrest was due to asphyxiation rather than hypothermia. However,
despite these grim statistics, a twenty-minute attempt at CPR is reasonable.
HYPOTHERMIA
For persons buried in avalanches who are extricated alive, trauma and hypothermia are the
most urgent medical problems that require treatment. The therapy administered depends
upon the severity of the hypothermia and is described in Chapter 26: Cold Injuries .
Traumaticinjuriesexacerbatetheonsetandprogressionofhypothermia.Evenrelatively
short burial times can result in a more severe level of hypothermia. Figure 30-2 is an
algorithm for the triage of individuals who have been buried that guides rescuers about
whether to discontinue efforts, whether to make a maximum effort, possibly at some risk,
and whether to transport for treatment of severe hypothermia.