Suspension syndrome: a scoping review and recommendations from the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

BACKGROUND: Suspension syndrome describes a multifactorial cardio-circulatory collapse during passive hanging on a rope or in a harness system in a vertical or near-vertical position. The pathophysiology is still debated controversially. AIMS: The International Commission for Mountain Emergency Medicine (ICAR MedCom) performed a scoping review to identify all articles with original epidemiological and medical data to understand the pathophysiology of suspension syndrome and develop updated recommendations for the definition, prevention, and management of suspension syndrome. METHODS: A literature search was performed in PubMed, Embase, Web of Science and the Cochrane library. The bibliographies of the eligible articles for this review were additionally screened. RESULTS: The online literature search yielded 210 articles, scanning of the references yielded another 30 articles. Finally, 23 articles were included into this work. CONCLUSIONS: Suspension Syndrome is a rare entity. A neurocardiogenic reflex may lead to bradycardia, arterial hypotension, loss of consciousness and cardiac arrest. Concomitant causes, such as pain from being suspended, traumatic injuries and accidental hypothermia may contribute to the development of the Suspension Syndrome. Preventive factors include using a well-fitting sit harness, which does not cause discomfort while being suspended, and activating the muscle pump of the legs. Expediting help to extricate the suspended person is key. In a peri-arrest situation, the person should be positioned supine and standard advanced life support should be initiated immediately. Reversible causes of cardiac arrest caused or aggravated by suspension syndrome, e.g., hyperkalaemia, pulmonary embolism, hypoxia, and hypothermia, should be considered. In the hospital, blood and further exams should assess organ injuries caused by suspension syndrome.

Physiological effects of providing supplemental air for avalanche victims. A randomised trial.

BACKGROUND: Survival from avalanche burial is dependent on time to extraction, breathing ability, air pocket oxygen content, and avoiding rebreathing of carbon dioxide (CO2). Mortality from asphyxia increases rapidly after burial. Rescue services often arrive too late. Our objective was to evaluate the physiological effects of providing personal air supply in a simulated avalanche scenario as a possible concept to delay asphyxia. We hypothesize that supplemental air toward victim's face into the air pocket will prolong the window of potential survival. METHODS: A prospective randomized crossover experimental field study enrolled 20 healthy subjects in Hemsedal, Norway in March 2019. Subjects underwent in randomized order two sessions (receiving 2 litres per minute of air in front of mouth/nose into the air pocket or no air) in a simulated avalanche scenario with extensive monitoring serving as their own control. RESULTS: A significant increase comparing Control vs Intervention were documented for minimum and maximum end-tidal CO2 (EtCO2), respiration rate, tidal volume, minute ventilation, heart rate, invasive arterial blood pressures, but lower peripheral and cerebral oximetry. Controls compared to Intervention group subjects had a lower study completion rate (26% vs 74%), and minutes in the air pocket before interruption (13.1 ± 8.1 vs 22.4 ± 5.6 vs), respectively. CONCLUSIONS: Participants subject to simulated avalanche burial can maintain physiologic parameters within normal levels for a significantly longer period if they receive supplemental air in front of their mouth/nose into the air pocket. This may extend the time for potential rescue and lead to increased survival.

Mountain rescue cardiopulmonary resuscitation: a comparison between manual and mechanical chest compressions during manikin cardio resuscitation.

AIM: Chest compression devices are useful during mountain rescue but may cause a delay in transport if not immediately available. The aims of this prospective observational study were to compare manual and mechanical cardiopulmonary resuscitation (CPR) during transport on a sledge connected to a snowmobile with a non-moving setting and to compare CPR quality between manual and two mechanical chest compression devices. METHODS: Sixteen healthcare providers simulated four different combined CPR scenarios on a sledge in a non-moving setting and during transport and two mechanical chest compression devices during transport on the sledge. The study was conducted in May 2015 in a mountain in Norway. The primary outcome measures were compression rate (compressions per minute), compression depth in millimetres, leaning (incomplete chest wall release after compression in millimetres) and chest compression fraction (fraction of total time were compression were performed). The results were analysed by descriptive and graphical methods and paired t-tests were used to compare the differences between techniques. RESULTS: We did not observe a significant difference between moving and non-moving conditions with respect to manual compression rate (p=0.34), compression depth (p=0.50) or leaning (p=0.92). However, both the manual compression depth (p<0.001) and the leaning (p=0.04) showed a significantly larger variance during the moving runs. CONCLUSION: Manual chest compression is possible on a snowmobile during transport even in challenging terrain. This experimental study shows that high-quality chest compressions and manual ventilation can be performed in an intubated patient during a short-term transportation on a sledge.

[Avalanche accidents and treatment of avalanche victims]. / Skredulykker og behandling av skredtatte.

Avalanches may be provoked spontaneously or as a result of human activity, and they trigger the need for considerable rescue resources. Avalanche search and rescue operations are complex and characterised by physical and mental stress. The guidelines for resuscitation of avalanche victims may be perceived as complex and abstruse, which can lead to suboptimal treatment and an increased strain on rescue teams. The purpose of this article is to summarise the principles for medical treatment of avalanche victims.

The impact of environmental factors in pre-hospital thermistor-based tympanic temperature measurement: a pilot field study.

BACKGROUND: Few pre-hospital services have the possibility to accurately measure core temperature (T core). Non-invasive estimation of T core will improve pre-hospital decision-making regarding the triage and management of hypothermic patients. Thermistor-based tympanic temperature (T tymp) correlates well with T core in controlled studies; however, little is known about the feasibility of using T tymp under field conditions. This study assessed the impact of pre-hospital environmental factors on the accuracy of T tymp . Deep rectal temperature (T rect) was used as a substitute for T core . METHODS: Normothermic volunteers (n = 13) were exposed to four simulated field conditions producing local cooling of the head and ear canal. After exposure, T tymp was recorded every 15 s for 10 min and compared with T rect . Descriptive analysis and Bland-Altman plots were used to assess agreement. RESULTS: Immediately after exposure mean T tymp was low, but increased rapidly and reached an apparent steady state after 3-5 min. After 5 and 10 min, the mean temperature difference (∆T rect-tymp) ranged from 1.5-3.2 °C (SD = 0.5) and 1.2-2.0 °C, respectively. T rect remained unchanged throughout the study period. CONCLUSIONS: After surface cooling of head and neck, T tymp did not accurately reflect core temperature within the first 10 min of measurement. The variation of ∆T rect-tymp was low after 10 min, regardless of the initial degree of cooling. With the risk of over-triage, T tymp may at this point provide an indication of T core and also exhibit a trend. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02274597.

Managing moderate and severe pain in mountain rescue.

AIMS: We aimed to describe evidence-based options for prehospital analgesia, and to offer practical advice to physicians and nonphysicians working in mountain rescue. METHODS: A literature search was performed; the results and recommendations were discussed among the authors. Four authors considered a scenario. The final article was discussed and approved by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) in October 2013. RESULTS AND RECOMMENDATIONS: Many health care providers fail to recognize, assess, and treat pain adequately. Assessment scales and treatment protocols should be implemented in mountain rescue services to encourage better management of pain. Specific training in assessing and managing pain is essential for all mountain rescuers. Persons administrating analgesics should receive appropriate detailed training. There is no ideal analgesic that will accomplish all that is expected in every situation. A range of drugs and delivery methods will be needed. Thus, an 'analgesic module' reflecting its users and the environment should be developed. The number of drugs carried should be reduced to a minimum by careful selection and, where possible, utilizing drugs with multiple delivery options. A strong opioid is recommended as the core drug for managing moderate or severe pain; a multimodal approach may provide additional benefits.

Recurrent sagittal sinus thrombosis occurring at high altitude during expeditions to Cho Oyu.

We report the case of a previously healthy 32-year-old man presenting with severe headache on 2 separate expeditions to Cho Oyu (8201 m). No brain imaging was performed after the first expedition. On the second expedition, thrombosis of the superior sagittal sinus was detected. Investigations for hypercoagulable states, including polycythemia, were negative. He had no neurological symptoms except headache, vomiting, and slight drowsiness. In retrospect, there are strong indications that cerebral thrombosis caused his headache on the first expedition as well. Severe headache occurring at high altitude that persists despite adequate treatment for high-altitude cerebral edema should raise suspicion of a cerebrovascular disorder.