Original Investigation
Caring for the Critically Ill Patient
Respiratory Gas Shifts to Delay Asphyxiation in Critical Avalanche Burial: A Randomized Clinical Trial
Frederik Eisendle, Giulia Roveri, Simon Rauch, et al
JAMA 2025;334;(19):1720-1727
doi:10.1001/jama.2025.16837
Key Points
Question Does a novel device delay the onset of hypoxemia and hypercapnia during critical avalanche burial by enhancing airflow to users’ airways?
Findings Median burial durations were 35.0 minutes in the intervention group, with no events (defined as Spo2<80%), and 6.4 minutes in the control group, with 7 events. The device demonstrated its efficacy in simulated burial scenarios delaying hypoxemia and hypercapnia, and stabilizing ventilatory and cardiovascular parameters.
Meaning Integrating this innovative technology into personal avalanche safety equipment, alongside existing tools like avalanche airbags and transceivers, could increase survival rates by extending the time available for successful rescue.
Abstract
Importance People who are critically buried by an avalanche typically die of asphyxia within 35 minutes, often making timely rescue impossible. The development of new strategies to delay asphyxiation is crucial to improve survival rates.
Objective To investigate the efficacy of a novel, user-carried avalanche safety device that delivers airflow from avalanche debris to the user’s airway without requiring supplemental oxygen or a mouthpiece.
Design, Setting, and Participants This randomized, blinded, clinical trial was organized by 4 institutions and conducted at 1 field location in Italy from January to March 2023. Healthy volunteers aged 18 to 60 years were enrolled. Trial participants underwent a critical snow burial simulation while in a prone position covered by at least 50 cm of snow. Vital parameters were continuously monitored throughout the simulation to ensure participant safety and to collect physiological data.
Interventions Participants were randomized to the safety device group (using the Safeback SBX device) or the control group (using a sham device). The safety device group completed an unblinded control in which the participants who remained buried after 35 minutes were seamlessly transferred to the sham device.
Main Outcomes and Measures The primary outcome measure was the time to oxygen saturation as measured by pulse oximetry (Spo2) less than 80% (event) during 35 minutes of monitoring, comparing intervention and control groups. Secondary outcomes included oxygen and carbon dioxide concentrations at different distances in the snow.
Results Of 36 randomized participants, 24 performed and completed the trial and were included in the final analysis. The median (IQR) age was 27 (25-32) years, and 13 (54%) were male. In the safety device group, the median (IQR) burial duration was 35.0 (35.0-35.0) minutes and there were no events; in the control group, the median (IQR) burial duration was 6.4 (4.8-13.5) minutes and there were 7 events. The safety device group had a significantly lower risk of termination due to Spo2 less than 80% (P < .001 for both log-rank and Breslow tests). Carbon dioxide in the air pocket was 1.3% (95% CI, 1.0%-1.6%) vs 6.1% (95% CI, 5.1%-7.1%) and oxygen was 19.8% (95% CI, 19.5%-20.1%) vs 12.4% (95% CI, 11.2%-13.5%) at the same points in the safety device and control groups, respectively.
Conclusions and Relevance A user-carried avalanche safety device that delivers airflow from avalanche debris to the user’s airways without requiring supplemental oxygen delayed critical hypoxemia and hypercapnia during simulated critical burial.
Trial Registration ClinicalTrials.gov Identifier: NCT05779540
