Article, Emergency Medicine

Cardiac arrest at high elevation with a favorable outcome

a b s t r a c t

A 36-year-old man started to climb Mount Fuji (3776 m above sea level: ASL), from the Gotemba new fifth station (2400 m ASL). He had no significant medical history, and this was his first attempt to climb such a high mountain. He began feeling Chest discomfort but continued to climb. When he reached the ninth station of the mountain (3600 m ASL), he lost consciousness. One individual immediately provided basic life support using an Automated external defibrillator that was located in the station. After electroshocks, he regained consciousness. He was transported to the fifth station, where an ambulance could approach, in a large crawler. When the medical staff, who were transported via helicopter and ambulance, examined him near the fifth station, he still complained of chest discomfort. A single spray of nitroglycerin and aspirin (200 mg) was administered. He was transported to the Cardiac Care Unit via ambulance and helicopter under escort by a physician. A chest computed tomography angiogram indicated triple-vessel disease. He was discharged without any Neurological deficits after undergoing bypass surgery.

In high mountains that can be easily accessed by amateur climbers who may have cardiac disease, the placement

of AED devices and the establishment of the Chain of survival from the scene to the intensive care unit are essential for obtaining a favorable outcome when a climber suffers cardiac arrest.

(C) 2016

When climbing high mountains, humans are exposed to hypoxia and cold. These factors, in combination with the increased oxygen consumption that is required due to climbing, can lead to lethal events [1-3]. Although the Incidence of cardiac arrest in high mountains is low, the rescuer Response times are long compared to the urban setting; thus, the prognosis of cardiac arrest is often poor [4]. We herein report a case of cardiac arrest that occurred on a high mountain in which a favorable outcome was obtained to emphasize the importance of the chain of survival.

A 36-year-old man started to climb Mount Fuji, the highest mountain in Japan (3776 m above sea level: ASL), from the Gotemba new fifth station (2400 m ASL). He had no significant medical history, and this was his first attempt to climb such a high mountain. He began experiencing chest discomfort but continued to climb. When he

? Grant: This manuscript received financial support from the Ministry of Education, Culture, Sports, Science and Technology (MEXT)-Supported Program for the Strategic Research Foundation at Private Universities, 2015-2019 concerning [The constitution of total researching system for comprehensive disaster, medical management, corresponding to wide-scale disaster] (no grant number).

* Corresponding author: Department of Cardiovascular Surgery, Numazu City Hospital, Zip code 410-2295, 1129 Nagaoka, Izunokuni City, Shizuoka, Japan.

E-mail address: [email protected] (Y. Yanagawa).

reached the ninth station of the mountain (3600 m ASL) at 09:30 AM, he lost consciousness. One of the people with the patient was a cabin attendant and was a provider of basic cardiac life support (BLS). This individual immediately provided BLS using an automated external defi- brillator (AED) that was located in the station. After three electroshocks, the AED indicated no need for chest compression, and the patient quickly regained consciousness (Fig. 1). When the members of the mountain rescue team examined the patient at 10:18 AM, he exhibited full consciousness, his heart rate was 100 beats per minute (BPM) and his SpO2 level was 88% under room air. With the provision of oxygen, his SpO2 level increased to 98%. He was transported from to the fifth station, where an ambulance could approach, in a large crawler. When the medical staff (who were transported via helicopter and ambulance) examined him near the fifth station at 11:47 AM, he still complained of chest discomfort. He exhibited full consciousness, his systolic blood pressure was 188/94 mm Hg, his heart rate was 90 beats per minute (BPM) and his SpO2 level was 98% under 2 l of oxygen per minute. An electrocardiogram showed an inverted T wave at the III lead. A single spray of nitroglycerin and aspirin (200 mg) was administered. He was transported to Numazu City Hospital (7 m ASL) at 01:43 PM via ambulance and helicopter under escort of a physician. The electrocardi- ography and cardiac sonography findings suggested acute myocardial

http://dx.doi.org/10.1016/j.ajem.2016.10.045

0735-6757/(C) 2016

661.e6 Y. Yanagawa et al. / American Journal of Emergency Medicine 35 (2017) 661.e5661.e7

infarction at the posterior wall. A chest computed tomography angiogram indicated triple-vessel disease (Fig. 2). He was discharged without any neurological deficits after undergoing bypass surgery.

A key point in obtaining the favorable outcome in this case was the

continuity of the chain of survival, which included the immediate provi- sion of BLS by a trained individual, early access to an AED, obtaining secure transportation for the descent from the 9th station to the 5th station of the mountain, and the transfer from the 5th station to the intensive care unit under escort by a physician and a nurse. AED and Public access defibrillation have become cornerstones in the chain of survival in modern cardiopulmonary resuscitation. Most studies on AED and PAD have been performed in urban areas. However, evidence for their utility in sparsely populated rural areas is scarce. Strohle et al. performed a review of the literature and concluded that the introduction of AED programs and emergency medical systems, even in rural areas, was essential for increasing the survival of out-of- hospital cardiac arrest patients [5]. High-altitude travel for mountain climbing, trekking, or sightseeing has become very popular [6-10]. As such, many amateur climbers, who may potentially have cardiac dis- ease, climb Mount Fuji [9,10]. As High altitude may exacerbate underly- ing cardiac or pulmonary disease, the placement of AED devices and the establishment of the chain of survival from the scene to the intensive care unit are essential for obtaining a favorable outcome [3]. AEDs have already been placed in the most stations of Mount Fuji, and most of the employees at the station have been trained in BLS [11,12].

In high mountains that are easily accessed by amateur climbers, who may have cardiac disease, the placement of AED devices and the establishment of the chain of survival from the scene to the intensive

care unit are essential for obtaining a favorable outcome when a climber

Fig. 2. The chest computed tomography angiogram on arrival. The chest computed

suffers cardiac arrest.

tomography angiogram shows triple-vessel disease.

Fig. 1. The Automated external defibrillator record. The record shows ventricular fibrillation.

Y. Yanagawa et al. / American Journal of Emergency Medicine 35 (2017) 661.e5661.e7 661.e7

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