Brugger Are ILCOR and ICAR MEDCOM guidelines - IKAR-CISA

Institute of Mountain Emergency Medicine

Institute of Mountain Emergency Medicine 

AVALANCHE ACCIDENT 

ILCOR Guidelines 2010 

ICAR MEDCOM algorithm 2011 

Hermann Brugger


ICAR MEDCOM recommendations 1996/2001






Incidence of avalanche victims with OHCA 

rewarmed with ECC in Tyrol (A) 1987-2007 

Incidence of hypothermic avalanche victims rewarmed with ECC at the Innsbruck 

University Hospital 1987-2007 

Anzahl der Wiedererwärmungen 

4 

3 

2 

1 

2 

1 3 3 

1 

1 

Introduction of ICAR MEDCOM 

triage algorithm 

1 1 1 1 

2 

1 

2 

survivor 

non survivor 

1 1 

0 

0 0 0 0 0 0 0 0 

1987 

1988 

1989 

1990 

1991 

1992 

1993 

1994 

1995 

1996 

1997 

1998 

1999 

2000 

2001 

2002 

2003 

2004 

2005 

2006 

2007 

Jahr 

Plankensteiner J. Avalanche victims with OHCA in Tyrol 1987-2009


Compliance on ICAR MEDCOM recommendations for 

avalanche ICAR Medcom victims with Recommendations OHCA in Tyrol (A) 1987-2007 2001 

Patent airway +/- airpocket 



Compliance on ICAR MEDCOM recommendations for 

avalanche ICAR Medcom victims with Recommendations OHCA in Tyrol (A) 1987-2007 2001 

Patent airway +/- airpocket 

Only 4 of 34 (12%) 

patients with an air 

pocket received 

ECC rewarming 



European Resuscitation Council 

Article of the month June 2010

AHA & ERC 

CoSTR Guidelines ILCOR 2010 



ICAR MEDCOM recommendations 2011 

Intended for use by 

physicians and 

other advanced life 

support skilled 

clinicians 

Hermann Brugger, Jeff Boyd, 

Fidel Elsensohn, Peter Paal, 

Giacomo Strapazzon,Eveline 

Winterberger, Ken Zafren


ICAR MEDCOM recommendations 2011



Gentle extrication. Core temperature + ECG 

monitoring, spinal immobilization, oxygen, 

insulation, hot packs on trunk; intravenous or 

intraosseous line only if within a few minutes; 

trauma treatment if indicated.





Clinicians may consider not to start or stopping CPR if 

it is associated with increased risk to the rescue 

team.



If duration of burial is unknown 

core temperature may be a 

substitute.





Transport victims with 

signs of any injury to a 

medical centre. Initiate 

CPR including ventilations 

and chest compressions if 

necessary.









Hospital capable of active rewarming such as 

forced air or internal rewarming.



Patients with unstable 

circulation should be 

transferred to ECC 

rewarming.

















With K+ >12 mmol/l, consider stopping resuscitation; 

in an adult with K+ >8 mmol/l CPR may be 

terminated





„No hypothermic avalanche 

victim with a patent airway 

is dead until rewarmed and 

dead“



„Hypothermic avalanche 

victims with a patent 

airway must be 

resuscitated and 

rewarmed“

Thanks to the writing group 

Jeff Boyd (CAN) 

Peter Paal (A) 

and all 

ICAR MEDCOM fellows

Brugger Are ILCOR and ICAR MEDCOM guidelines - IKAR-CISA

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