• Peter Paal, Giacomo Strapazzon, Patrick Braun, Peter Paul Ellmauer, Daniel Carl Schroeder, Guenther Sumann, Andreas Werner, Volker Wenzel, Markus Falk, and Hermann Brugger.
• Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria. peter.paal@uki.at
• Resuscitation. 2013 Feb 1;84(2):239-43.

Background And AimThe majority of avalanche victims who sustain complete burial die within 35min due to asphyxia and injuries. After 35min, survival is possible only in the presence of a patent airway, and an accompanying air pocket around the face may improve survival. At this stage hypothermia is assumed to be an important factor for survival because rapid cooling decreases oxygen consumption; if deep hypothermia develops before cardiac arrest, hypothermia may be protective and prolong the time that cardiac arrest can be survived. The aim of the study was to investigate the combined effects of hypoxia, hypercapnia and hypothermia in a porcine model of avalanche burial.MethodsEight piglets were anaesthetised, intubated and buried under snow, randomly assigned to an air pocket (n=5) or ambient air (n=3) group.ResultsMean cooling rates in the first 10min of burial were -19.7±4.7°Ch(-1) in the air pocket group and -13.0±4.4°Ch(-1) in the ambient air group (P=0.095); overall cooling rates between baseline and asystole were -4.7±1.4°Ch(-1) and -4.6±0.2°Ch(-1) (P=0.855), respectively. In the air pocket group cardiac output (P=0.002), arterial oxygen partial pressure (P=0.001), arterial pH (P=0.002) and time to asystole (P=0.025) were lower, while arterial carbon dioxide partial pressure (P=0.007) and serum potassium (P=0.042) were higher compared to the ambient air group.ConclusionOur results demonstrate that hypothermia may develop in the early phase of avalanche burial and severe asphyxia may occur even in the presence of an air pocket.Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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