• David Eidenbenz, Frank Techel, Alexandre Kottmann, Valentin Rousson, Pierre-Nicolas Carron, Roland Albrecht, and Mathieu Pasquier.
• Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, BH 09, CHUV, 1011 Lausanne, Switzerland. Electronic address: david.eidenbenz@chuv.ch.
• Resuscitation. 2021 Sep 1; 166: 93-100.

BackgroundThe survival of completely buried victims in an avalanche mainly depends on burial duration. Knowledge is limited about survival probability after 60 min of complete burial.AimWe aimed to study the survival probability and prehospital characteristics of avalanche victims with long burial durations.MethodsWe retrospectively included all completely buried avalanche victims with a burial duration of ≥60 min between 1997 and 2018 in Switzerland. Data were extracted from the registry of the Swiss Institute for Snow and Avalanche Research and the prehospital medical records of the physician-staffed helicopter emergency medical services. Avalanche victims buried for ≥24 h or with an unknown survival status were excluded. Survival probability was estimated by using the non-parametric Ayer-Turnbull method and logistic regression. The primary outcome was survival probability.ResultsWe identified 140 avalanche victims with a burial duration of ≥60 min, of whom 27 (19%) survived. Survival probability shows a slight decrease with increasing burial duration (23% after 60 min, to <6% after 1400 min, p = 0.13). Burial depth was deeper for those who died (100 cm vs 70 cm, p = 0.008). None of the survivors sustained CA during the prehospital phase.ConclusionsThe overall survival rate of 19% for completely buried avalanche victims with a long burial duration illustrates the importance of continuing rescue efforts. Avalanche victims in CA after long burial duration without obstructed airway, frozen body or obvious lethal trauma should be considered to be in hypothermic CA, with initiation of cardiopulmonary resuscitation and an evaluation for rewarming with extracorporeal life support.Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.

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