• Resuscitation · Jun 2019

    Multicenter Study

    Cut-off values of serum potassium and core temperature at hospital admission for extracorporeal rewarming of avalanche victims in cardiac arrest: A retrospective multi-centre study.

    • Hermann Brugger, Pierre Bouzat, Mathieu Pasquier, Peter Mair, Julia Fieler, Tomasz Darocha, Marc Blancher, Matthieu de Riedmatten, Markus Falk, Peter Paal, Giacomo Strapazzon, Ken Zafren, and Monika Brodmann Maeder.
    • Institute of Mountain Emergency Medicine, EURAC research, Drususallee 1, 39100 Bolzano, Italy; Medical University Innsbruck, Austria; International Commission for Mountain Emergency Medicine ICAR MEDCOM. Electronic address: hermann.brugger@eurac.edu.
    • Resuscitation. 2019 Jun 1; 139: 222-229.

    AimEvidence of existing guidelines for the on-site triage of avalanche victims is limited and adherence suboptimal. This study attempted to find reliable cut-off values for the identification of hypothermic avalanche victims with reversible out-of-hospital cardiac arrest (OHCA) at hospital admission. This may enable hospitals to allocate extracorporeal life support (ECLS) resources more appropriately while increasing the proportion of survivors among rewarmed victims.MethodsAll avalanche victims with OHCA admitted to seven centres in Europe capable of ECLS from 1995 to 2016 were included. Optimal cut-off values, for parameters identified by logistic regression, were determined by means of bootstrapping and exact binomial distribution and served to calculate sensitivity, rate of overtriage, positive and negative predictive values, and receiver operating curves.ResultsIn total, 103 avalanche victims with OHCA were included. Of the 103 patients 61 (58%) were rewarmed by ECLS. Six (10%) of the rewarmed patients survived whilst 55 (90%) died. We obtained optimal cut-off values of 7 mmol/L for serum potassium and 30 °C for core temperature.ConclusionFor in-hospital triage of avalanche victims admitted with OHCA, serum potassium accurately predicts survival. The combination of the cut-offs 7 mmol/L for serum potassium and 30 °C for core temperature achieved the lowest overtriage rate (47%) and the highest positive predictive value (19%), with a sensitivity of 100% for survivors. The presence of vital signs at extrication is strongly associated with survival. For further optimisation of in-hospital triage, larger datasets are needed to include additional parameters.Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.

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