On-site treatment of avalanche victims: Scoping review and 2023 recommendations of the international commission for mountain emergency medicine (ICAR MedCom)

Resuscitation. 2023 Mar;184:109708. doi: 10.1016/j.resuscitation.2023.109708. Epub 2023 Jan 26.


Introduction: The International Commission for Mountain Emergency Medicine (ICAR MedCom) developed updated recommendations for the management of avalanche victims.

Methods: ICAR MedCom created Population Intervention Comparator Outcome (PICO) questions and conducted a scoping review of the literature. We evaluated and graded the evidence using the American College of Chest Physicians system.

Results: We included 120 studies including original data in the qualitative synthesis. There were 45 retrospective studies (38%), 44 case reports or case series (37%), and 18 prospective studies on volunteers (15%). The main cause of death from avalanche burial was asphyxia (range of all studies 65-100%). Trauma was the second most common cause of death (5-29%). Hypothermia accounted for few deaths (0-4%).

Conclusions and recommendations: For a victim with a burial time ≤ 60 minutes without signs of life, presume asphyxia and provide rescue breaths as soon as possible, regardless of airway patency. For a victim with a burial time > 60 minutes, no signs of life but a patent airway or airway with unknown patency, presume that a primary hypothermic CA has occurred and initiate cardiopulmonary resuscitation (CPR) unless temperature can be measured to rule out hypothermic cardiac arrest. For a victim buried > 60 minutes without signs of life and with an obstructed airway, if core temperature cannot be measured, rescuers can presume asphyxia-induced CA, and should not initiate CPR. If core temperature can be measured, for a victim without signs of life, with a patent airway, and with a core temperature < 30 °C attempt resuscitation, regardless of burial duration.

Keywords: Accidental Hypothermia; Avalanche; Emergency Medical Services; Extracorporeal Life Support; Hypothermia; Resuscitation; Triage.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asphyxia / therapy
  • Avalanches*
  • Cardiopulmonary Resuscitation*
  • Humans
  • Hypothermia* / therapy
  • Iron-Dextran Complex
  • Prospective Studies
  • Retrospective Studies


  • Iron-Dextran Complex