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Hypercapnia increases core temperature cooling rate during snow burial

¹Department of Medicine, Pulmonary and Critical Care Division, LDS Hospital, Salt Lake City 84143; ²Department of Medicine, Pulmonary and Critical Care Division, University of Utah, Salt Lake City 84108; ⁴Sorenson Genomics, Salt Lake City 84115; ³Granger Medical Clinic, West Valley City, Utah 84120; and ⁵Department of Emergency Medicine, Cooley Dickinson Hospital, Northampton, Massachusetts 01060

Submitted 16 May 2003 ; accepted in final form 2 December 2003

Previous retrospective studies report a core body temperature cooling rate of 3°C/h during avalanche burial. Hypercapnia occurs during avalanche burial secondary to rebreathing expired air, and the effect of hypercapnia on hypothermia during avalanche burial is unknown. The objective of this study was to determine the core temperature cooling rate during snow burial under normocapnic and hypercapnic conditions. We measured rectal core body temperature (T_re) in 12 subjects buried in compacted snow dressed in a lightweight clothing insulation system during two different study burials. In one burial, subjects breathed with a device (AvaLung 2, Black Diamond Equipment) that resulted in hypercapnia over 30-60 min. In a control burial, subjects were buried under identical conditions with a modified breathing device that maintained normocapnia. Mean snow temperature was -2.5 ± 2.0°C. Burial time was 49 ± 14 min in the hypercapnic study and 60 min in the normocapnic study (P = 0.02). Rate of decrease in T_re was greater with hypercapnia (1.2°C/h by multiple regression analysis, 95% confidence limits of 1.1-1.3°C/h) than with normocapnia (0.7°C/h, 95% confidence limit of 0.6-0.8°C/h). In the hypercapnic study, the fraction of inspired carbon dioxide increased from 1.4 ± 1.0 to 7.0 ± 1.4%, minute ventilation increased from 15 ± 7 to 40 ± 12 l/min, and oxygen saturation decreased from 97 ± 1 to 90 ± 6% (P < 0.01). During the normocapnic study, these parameters remained unchanged. In this study, T_re cooling rate during snow burial was less than previously reported and was increased by hypercapnia. This may have important implications for prehospital treatment of avalanche burial victims.

hypothermia; avalanche burial; avalanche survival

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