Department of Surgery, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria.
Department of Anaesthesiology and Intensive Care Medicine, Kufstein Hospital, Kufstein, Austria.
High Alt Med Biol. 2021 Jun;22(2):235-240. doi: 10.1089/ham.2020.0222. Epub 2021 Mar 24.
Mittermair, Christof, Eva Foidl, Bernd Wallner, Hermann Brugger, and Peter Paal. Extreme cooling rates in avalanche victims: case report and narrative review. . 22: 235-240, 2021. We report a 25-year-old female backcountry skier who was buried by an avalanche during ascent. A cooling rate of 8.5°C/h from burial to hospital is the fastest reported in a person with persistent circulation. A case report according to the CARE guidelines is presented. A literature search with the keywords "avalanche" AND "hypothermia" was performed and yielded 96 results, and the last update was on October 25, 2020. A narrative review complements this work. A literature search revealed four avalanche patients with extreme cooling rates (>5°/h). References of included articles were searched for further relevant studies. Nineteen additional pertinent articles were included. Overall, 32 studies were included in this work. An avalanche patient cools in different phases, and every phase may have different cooling rates: (1) during burial, (2) with postburial exposure on-site, and (3) during transport. It is important to measure the core temperature correctly, ideally with an esophageal probe. Contributing factors to fast cooling are sweating, impaired consciousness, no shivering, wearing thin monolayer clothing and head and hands uncovered, an air pocket, and development of hypercapnia, being slender. Rescuers should be prepared to encounter severely hypothermic subjects (<30°C) even after burials of <60 minutes. Subjects rescued from an avalanche may cool extremely fast the more contributing factors for rapid cooling exist. After avalanche burial (≥60 minutes) and unwitnessed cardiac arrest, chances of neurologically intact survival are small and depend on rapid cooling and onset of severe hypothermia (<30°C) before hypoxia-induced cardiac arrest.
米特迈尔、克里斯托夫、伊娃·福伊德尔、贝恩德·沃纳、赫尔曼·布鲁格和彼得·帕尔。雪崩受害者的极端冷却速率：病例报告和叙述性综述。22:235-240, 2021. 我们报告了一位 25 岁的女性山地滑雪者，她在登山时被雪崩掩埋。从掩埋到医院的冷却速度为 8.5°C/h，是有持续循环的人中报告的最快速度。根据 CARE 指南呈现了一个病例报告。使用关键字“雪崩”和“体温过低”进行了文献搜索，共得到 96 个结果，最后一次更新时间是 2020 年 10 月 25 日。这项工作还补充了叙述性综述。文献搜索发现了 4 名冷却速度极快的雪崩患者（>5°C/h）。还对纳入文章的参考文献进行了搜索，以寻找进一步的相关研究。共纳入了 19 篇额外的相关文章。总体而言，这项工作共纳入了 32 项研究。雪崩患者在不同阶段冷却，每个阶段可能有不同的冷却速率：（1）掩埋过程中，（2）掩埋后现场暴露，（3）运输过程中。重要的是要正确测量核心温度，理想情况下使用食管探头。快速冷却的促成因素包括出汗、意识障碍、不颤抖、穿着单薄的单层衣服且头部和手部未遮盖、空气袋和高碳酸血症的发展、身材消瘦。救援人员应准备好遇到体温过低（<30°C）的严重情况，即使在<60 分钟的掩埋后也是如此。存在更多快速冷却促成因素的情况下，从雪崩中获救的患者可能会极快地冷却。雪崩掩埋（≥60 分钟）和未目击的心脏骤停后，神经完整存活的机会很小，取决于快速冷却和缺氧性心脏骤停前出现严重体温过低（<30°C）。
