Ski Patroller Manual Cardiopulmonary Resuscitation During Rescue Toboggan Transport: Three Vermont Skier Cases of Cardiac Arrest With Neurologically Intact Survival and Practical Suggestions for Implementation.

Debate exists regarding safety and optimal technique for ski patrollers performing cardiopulmonary resuscitation (CPR) on cardiac arrest patients in a moving toboggan during rescue evacuation. Cases of successful outcomes after toboggan-transport (in-sled) manual (hands-on) or mechanical CPR by ski patrollers have not been described in the medical literature. This case series presents 3 adult resort skiers who experienced medical cardiac arrest in Vermont over the years 2024-25, and who received manual CPR in a moving rescue toboggan, leading to return of spontaneous circulation and subsequent neurologically intact hospital discharge. One case displayed signs of cognitive activity only during chest compressions, which suggests that manual CPR in a moving rescue toboggan can create brain perfusion. This study documents that after an initial period of on-scene stationary CPR and defibrillation, manual CPR may be safely continued in the appropriate circumstance by ski patrollers in a moving toboggan and can lead to successful outcomes for medical cardiac arrest. An educational opportunity exists. Practical suggestions and techniques are discussed for the implementation of safe and effective toboggan-transport CPR when indicated.