Noncompressible Chest Wall in Critically Buried Avalanche Victims with Cardiac Arrest: A Case Series.

David Eidenbenz, Alexandre Kottmann, Ken Zafren, Pierre-Nicolas Carron, Roland Albrecht, and Mathieu Pasquier. Noncompressible chest wall in critically buried avalanche victims with cardiac arrest: a case series. 00:00-00, 2024. In avalanche victims with cardiac arrest, a noncompressible chest wall or frozen body is a contraindication to initiating cardiopulmonary resuscitation. The evidence sustaining this recommendation is low. To describe the characteristics and prehospital management of critically buried avalanche victims declared dead on site, with and without noncompressible chest walls. Retrospective study including all critically buried avalanche victims declared dead on site by physicians of a helicopter emergency medical service in Switzerland, from 2010 to 2019. The primary outcome was the proportion of victims with a noncompressible chest wall reported in medical records. Secondary outcomes included victims' characteristics and the relevance of the criterion, noncompressible chest wall, for management. Among the 53 included victims, 12 (23%) had noncompressible chest walls. Victims with noncompressible chest walls had significantly longer burial durations (median 1,125 vs. 45 minutes; < 0.001) and lower core temperatures (median 14 vs. 32°C; = 0.01). The criterion, noncompressible chest wall, assessed in six victims, was decisive for declaring death on site in four victims. The presence of a noncompressible chest wall does not appear to be a sufficient criterion to allow to declare the death of critically buried avalanche victims. Further clinical information should be sought.