Survival of cardiac arrest patients on ski slopes: A 10-year analysis of the Northern French Alps Emergency Network

Abstract

AimIntense physical activity, cold and altitude make mountain sports a cause of increased risk of out-of-hospital cardiac arrest (OHCA). The difficulties of pre-hospital management related to this challenging environment could be mitigated by the presence of ski-patrollers in ski areas and use of helicopters for medical rescue. We assess whether this particular situation positively impacts the chain of survival compared to the general population. MethodsAnalysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2004 to 2014. Results19,341 OHCAs were recorded during the period, including 136 on-slope events. Compared to other OHCAs, on-slope patients were younger (56 [40–65] vs. 66 [52–79] years, p<0.001) and more often in shockable initial rhythm (41.2% vs 20.1%, p<0.001). Resuscitation was more frequently started by a witness (43.4% vs 26.8%, p<0.001) and the time to the first electric shock was shorter (7.5min vs 14min, p<0.001), whereas time to the advanced life support (ALS) rescue arrival did not differ. The 30-day survival rate was higher for on-slope arrests (21.3% vs 5.9%, p<0.001, RR=3.61). In multivariate analysis, on-slope CA remained a positive 30-day survival factor with a 2.6 odds ratio (95% confidence interval, 1.42–4.81, p=0.002). ConclusionDespite difficult access and management conditions, patients undergoing OHCAs on ski slopes presented a higher survival rate, possibly explained by a healthier population, the efficiency of resuscitation by ski-patrols and similar time to ALS facilities compared to other cardiac arrests.