Institute of Mountain Emergency Medicine, European Academy, Bozen/Bolzano, Italy.
High Alt Med Biol. 2011 Fall;12(3):199-205. doi: 10.1089/ham.2011.1025.
In North America and Europe, approximately 150 people die of avalanches per year, and fatalities are presumed to be many times higher in developing countries. Four factors are decisive for survival: grade of burial, duration of burial, presence of an air pocket and a free airway, and severity of trauma. According to Swiss data, the overall mortality rate with avalanche burial is 23%, but it largely depends on the grade of burial. While the mortality rate is 52.4% in completely buried (head below the snow) victims in the Swiss population, it is only 4.2% in partially buried (head free) victims. Additionally, survival in completely buried victims drops to 30% within the first 35 min, initially due to death from lethal trauma, followed by asphyxia in 20-35 min. Thereafter, survival decreases more gradually and victims who are not fatally injured and are able to breath under the snow slowly succumb to hypoxia, hypercapnia, and hypothermia. In the absence of fatal injuries, rescue strategies depend on the duration of burial and the victim's core temperature. With a burial time<35 min, survival depends on preventing asphyxia by rapid extrication, adequate airway management, and cardiopulmonary resuscitation. With a burial time>35 min, tackling hypothermia is of utmost importance. Therefore, gentle extrication and continuous core temperature and electrocardiogram monitoring are recommended. Pulseless victims with a patent airway and a core temperature<32°C should receive uninterrupted cardiopulmonary resuscitation and be transported to a hospital with extracorporeal rewarming facilities.
在北美和欧洲，每年约有 150 人死于雪崩，而在发展中国家，死亡人数据推测要高出许多倍。有四个因素对生存至关重要：掩埋程度、掩埋时间、是否有空腔和自由气道以及创伤严重程度。根据瑞士的数据，整体雪崩掩埋死亡率为 23%，但这在很大程度上取决于掩埋程度。在瑞士人口中，完全掩埋（头部低于积雪）的受害者死亡率为 52.4%，而部分掩埋（头部自由）的受害者死亡率仅为 4.2%。此外，在完全掩埋的受害者中，在最初的 35 分钟内死亡率下降到 30%，最初是由于致命创伤而死亡，然后在 20-35 分钟内窒息。此后，死亡率逐渐下降，未受致命伤害且能够在雪地下呼吸的受害者会慢慢因缺氧、高碳酸血症和低体温而死亡。在没有致命伤害的情况下，救援策略取决于掩埋时间和受害者的核心体温。掩埋时间<35 分钟时，生存取决于通过快速解救防止窒息、充分的气道管理和心肺复苏。掩埋时间>35 分钟时，解决低体温至关重要。因此，建议温和解救并持续监测核心体温和心电图。有通畅气道和核心体温<32°C 的无脉受害者应接受不间断的心肺复苏，并送往有体外复温设施的医院。
