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Master Thesis

Analyse de la survie des patients avalanchés en arrêt cardiaque dans les Alpes du Nord

Abstract : Aim: Criteria to prolong resuscitation after cardiac arrest (CA) induced by avalanche burial are critical due to the role of associated profound hypothermia. We sought parameters associated with survival in a cohort of victims of complete avalanche burial. Methods: Retrospective observational study from 1994 to 2013 in the Northern French Alps with on-scene CA patients after avalanche burial. Criteria associated with survival at the intensive care unit (ICU) discharge were collected on the scene and at the admission to Level-1 trauma center. Neurological outcome was assessed at 3 months using cerebral performance category. Results: Forty-eight patients were studied. They were buried for a median time of 43 min (25-76 min; 25-75th percentiles) and had a pre-hospital body core temperature of 28.0°C (26.0-30.7). Eighteen patients had pre-hospital return of spontaneous circulation and 30 had refractory CA. Twenty-one patients had extracorporeal life support for rewarming. Eight patients survived at ICU discharge and 3 patients had favorable neurological outcome at 3 months. Pre-hospital parameters associated with survival were the presence of air pocket and a rescue collapse. On admission, survivors had lower serum potassium concentration than non-survivors: 3.2 mmol/L (2.7-4.0) versus 5.6 mmol/L (4.2-8.0), respectively (P<0.01). They also had normal prothrombin and activated partial thromboplastin compared to non-survivors. Conclusions: Our findings indicate that survival after avalanche burial and on-scene CA is rarely associated with favourable neurological outcome. Among criteria associated with survival, normal blood coagulation on admission should deserve further confirmation.
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Master Thesis
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Submitted on : Monday, October 13, 2014 - 9:48:28 AM
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  • HAL Id : dumas-01074130, version 1


Yvonnick Boué. Analyse de la survie des patients avalanchés en arrêt cardiaque dans les Alpes du Nord. Médecine humaine et pathologie. 2014. ⟨dumas-01074130⟩



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