• Paul G Firth, Hui Zheng, Jeremy S Windsor, Andrew I Sutherland, Christopher H Imray, G W K Moore, John L Semple, Robert C Roach, and Richard A Salisbury.
• Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA. pfirth@partners.org
• BMJ. 2008 Jan 1;337:a2654.

ObjectiveTo examine patterns of mortality among climbers on Mount Everest over an 86 year period.DesignDescriptive study.SettingClimbing expeditions to Mount Everest, 1921-2006.Participants14,138 mountaineers; 8030 climbers and 6108 sherpas.Main Outcome MeasureCircumstances of deaths.ResultsThe mortality rate among mountaineers above base camp was 1.3%. Deaths could be classified as involving trauma (objective hazards or falls, n=113), as non-traumatic (high altitude illness, hypothermia, or sudden death, n=52), or as a disappearance (body never found, n=27). During the spring climbing seasons from 1982 to 2006, 82.3% of deaths of climbers occurred during an attempt at reaching the summit. The death rate during all descents via standard routes was higher for climbers than for sherpas (2.7% (43/1585) v 0.4% (5/1231), P<0.001; all mountaineers 1.9%). Of 94 mountaineers who died after climbing above 8000 m, 53 (56%) died during descent from the summit, 16 (17%) after turning back, 9 (10%) during the ascent, 4 (5%) before leaving the final camp, and for 12 (13%) the stage of the summit bid was unknown. The median time to reach the summit via standard routes was earlier for survivors than for non-survivors (0900-0959 v 1300-1359, P<0.001). Profound fatigue (n=34), cognitive changes (n=21), and ataxia (n=12) were the commonest symptoms reported in non-survivors, whereas respiratory distress (n=5), headache (n=0), and nausea or vomiting (n=3) were rarely described.ConclusionsDebilitating symptoms consistent with high altitude cerebral oedema commonly present during descent from the summit of Mount Everest. Profound fatigue and late times in reaching the summit are early features associated with subsequent death.

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