International Snow Science Workshop Proceedings - Montana State University Library

Item: INTERMITTENT VENTILATION DURING EXCAVATION OF A BURIED AVALANCHE PATIENT - AN EXPERIMENTAL PROSPECTIVE MANIKIN PROOF OF CONCEPT

• • Title: INTERMITTENT VENTILATION DURING EXCAVATION OF A BURIED AVALANCHE PATIENT - AN EXPERIMENTAL PROSPECTIVE MANIKIN PROOF OF CONCEPT

    Proceedings: Proceedings, International Snow Science Workshop, Whistler, BC, Canada, 2026

    Authors:

    • Manuel Genswein  [ MountainSafety.info Workgroups for Emergency Mountain Medicine and Avalanche Rescue, Switzerland ]
    • Scott McIntosh  [ MountainSafety.info Workgroups for Emergency Mountain Medicine and Avalanche Rescue, Switzerland ]  [ Department of Emergency Medicine, University of Utah Health, USA ]
    • Marcelo Parada  [ MountainSafety.info Workgroups for Emergency Mountain Medicine and Avalanche Rescue, Switzerland ]  [ Emergency Department, San Martin de los Andes Hospital, Argentina ]
    • Darryl Macias  [ MountainSafety.info Workgroups for Emergency Mountain Medicine and Avalanche Rescue, Switzerland ]  [ University of New Mexico Department of Emergency Medicine, International Mountain Medicine Center, New Mexico, USA ]
    • Kyle McLaughlin  [ Department of Emergency Medicine, Canmore General Hospital, Canada ]
    • Sven Christjar Skaiaa  [ MountainSafety.info Workgroups for Emergency Mountain Medicine and Avalanche Rescue, Switzerland ]  [ Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway ]
    • Peter Paal  [ MountainSafety.info Workgroups for Emergency Mountain Medicine and Avalanche Rescue, Switzerland ]  [ Department of Anaesthesia and Intensive Care, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria ]  [ Austrian Board for Mountain Safety, Innsbruck, Austria ]

    Date: 2026-09-28

    Abstract: Complete burial in an avalanche leads to asphyxia-induced respiratory suppression and respiratory arrest. The timeline is influenced by the properties of the debris as well as the crystalline structure. Once respiratory arrest has occurred, hypoxia leads within minutes to severe, irreversible neurologic damage, followed by cardiac arrest due to absolute depletion of oxygen. Due to insulation of multi-layer clothing as well as the air content of the debris, the cooling rate of avalanche patients is, with very few exceptions (Pasquier et al., 2015; and Rauch et al., 2023), within a low 1°C to 3°C per hour (Brown et al., 2012; and Putzer et al. 2010). Therefore, the neuroprotective effect of hypothermia is in most cases too slow to prevent severe neurologic damage. In companion and fast organized rescue (i.e. ski patrol), reaching the head of the patient within 5 to 15min of burial duration is realistic. While many patients will already suffer severe, non-self-recoverable respiratory suppression or respiratory arrest, the majority will not have suffered cardiac arrest yet. Without rescue breaths, these patients are very likely to progress towards a further depletion of oxygen, neurologic damage and cardiac arrest. AvaLife sets as first priority a good neurologic outcome for the patient by reversing the respiratory problem with immediate first responder rescue breaths. The most likely position of the patient will be prone. Initiating rescue breaths in this position while the pelvis and lower extremities may still be firmly packed in the snow is extremely challenging. Completely freeing the entire patient takes at least 5 to 10 min. We developed a protocol which brings the airway in a position compatible with rescue breaths. Further, rescue breaths are performed continuously (when space and resources allow for it), or intermittently (intermittent ventilation, iVent). These strategies allow one rescuer to eventually completely free the patient while giving sequences of five rescue breaths every ~30 seconds. CPR for avalanche patients in hypoxic cardiac arrest remains important but second priority. Following AvaLife's Greatest Good for the Greatest Number strategy, CPR duration is limited to 6 min in case of multiple burials/patients and shortage of resources.

    Object ID: ISSW2026_P1.63.pdf

    DOI: https://doi.org/10.15788/1790098875

    Language of Article: English

    Presenter(s): Jakub Hornowski

    Keywords: avalanche rescue, asphyxia, respiratory arrest, rescue breathing, intermittent ventilation, iVent, companion rescue

    Page Number(s): 2413 - 2421

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