A fascinating case report was recently published in Resuscitation. A young female speleologist was avalanched in the polish Tatra mountains. As she had access to an air pocket and some degree of ventilation she didn’t to succumb to the asphyxiation that kills most buried avalanche victims. Instead, she was gradually cooled to a core temperature of below 17° C.
As is often the case with the hypothermic avalanche victims, she went into VF cardiac arrest during extrication and initial evacuation. Likely due to after-drop or to the electromechanical instability for which hypothermia victims are notorious. This VF persisted for a total of 6h and 45 minutes after which she was successfully electroconverted after ECMO rewarming to a core temperature of 24,8° C.
The truly interesting part is how she for for 5 hours and 45 minutes persisted on manual compressions and LUCAS only. Evacuation was delayed due the helicopter being grounded for weather issues and the on-foot evacuation was prolonged because of difficult terrain.
Incredibly, she was discharged without any physical or mental sequelae. This case is a powerful demonstration of the protective effects of hypothermia as well as of the potent chain of survival and hard work the polish rescuers and clinicians put in.
Case report lives here (Open Access):
Edit: Fixed link.
The longest persisting ventricular fibrillation with an excellent outcome – 6h 45min cardiac arrest. Kosinski S, Darocha T, Jarosz A, Migiel L, Zelias A, Marcinkowski W, Filip G, Galazkowski R, Drwila R. Resuscitation. 2016 Jun 6.