This chapter is based on following publications:
• Brugger H., Durrer B., Elsensohn F., Paal P., Strapazzon G., Winterberger E., Zafren K., Boyd J. Resuscitation of avalanche victims: Evidence- -based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM): intended for physicians and other advanced life support personnel. Resuscitation 2013; 84: 539–546.
• Brugger H., Paal P., Boyd J. Prehospital resuscitation of the buried avalanche vict im. High Altitude Medicine & Biology 2011; 12: 199–205.
• Truhlář A., Deakin C.D., Soar J., Khalifa G.E., Alfonzo A., Bierens J.J., Brattebo G., Brugger H., Dunning J., Hunyadi-Anticevic S., Koster R.W., Lockey D.J., Lott C., Paal P., Perkins G.D., Sandroni C., Thies K.C., Zideman D.A., Nolan J.P. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95: 148–201.
In North America and Europe, approximately 165 people die of avalanches per year. Four factors are decisive for survival: grade and duration of burial, presence of a free airway, and severity of trauma. The overall mortality rate is 23%, but 52.4% in completely buried (i.e. head below the snow) victims in contrast to 4.2% in partially buried (i.e. head free) victims. Survival in completely buried victims drops to 30% within the first 35 minutes due to trauma and asphyxia. Thereafter survival decreases more gradually and victims slowly succumb to a trias of hypoxia, hypercapnia and hypothermia if they are able to breath. In the absence of fatal injuries, rescue strategies depend primarily on trauma, duration of burial, the victim's core temperature and the patency of the airway. In 2015, the European Resuscitation Council proposed an algorithm for the management of avalanche victims. With a burial time < 60 minutes (or core temperature ≥ 30°C) rapid extrication and prevention of asphyxia is essential, with adequate airway management and cardiopulmonary resuscitation. With a burial time > 60 minutes or core temperature < 30°C tackling severe hypothermia should be expected. Gentle extrication and continuous core temperature and cardiac monitoring are recommended. Pulseless victims with a patent airway, duration of burial > 60 minutes or a core temperature < 30°C should receive continuous or intermittent cardiopulmonary resuscitation and be transported to a hospital with extracorporeal rewarming facilities.