International guidelines recommend using extracorporeal
rewarming in all hypothermic avalanche victims with prolonged
cardiac arrest if they have patent airways and a plasma
potassium level≤12 mmol/L. The aim of this study was to evaluate outcome data to determine if available experience with extracorporeal
rewarming of avalanche victims supports this recommendation. At Innsbruck Medical University Hospital, 28 patients with hypothermic
cardiac arrest following an avalanche accident were resuscitated using
extracorporeal circulation. Of these patients, 25 were extricated from the snow masses with no vital signs and did not survive to hospital discharge. Three patients had witnessed
cardiac arrest after extrication and a core temperature of 21.7°C, 22°C, and 24.0°C, two of whom survived long-term with full neurological recovery. A search of the literature revealed only one asystolic avalanche victim with unwitnessed hypothermic
cardiac arrest (core temperature 19°C) surviving long-term. All other avalanche victims in the medical literature surviving prolonged hypothermic
cardiac arrest suffered witnessed arrest after extrication with a core temperature below 24°C. Our results suggest that prognosis of hypothermic avalanche victims with unwitnessed asystolic
cardiac arrest and a core temperature>24°C is extremely poor. Available outcome data do not support the use of extracorporeal
rewarming in these patients.