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• W3092870017 abstract "Determination of death requires specific knowledge, training, and experience in most cases. It can be particularly difficult when external conditions, such as objective hazards in mountains, prevent close physical examination of an apparently lifeless person, or when examination cannot be accomplished by an authorized person. Guidelines exist, but proper use can be difficult. In addition to the absence of vital signs, definitive signs of death must be present. Recognition of definitive signs of death can be problematic due to the variability in time course and the possibility of mimics. Only clear criteria such as decapitation or detruncation should be used to determine death from a distance or by laypersons who are not medically trained. To present criteria that allow for accurate determination of death in mountain rescue situations, the International Commission for Mountain Emergency Medicine convened a panel of mountain rescue doctors and a forensic pathologist. These recommendations are based on a nonsystematic review of the literature including articles on determination of death and related topics. Determination of death requires specific knowledge, training, and experience in most cases. It can be particularly difficult when external conditions, such as objective hazards in mountains, prevent close physical examination of an apparently lifeless person, or when examination cannot be accomplished by an authorized person. Guidelines exist, but proper use can be difficult. In addition to the absence of vital signs, definitive signs of death must be present. Recognition of definitive signs of death can be problematic due to the variability in time course and the possibility of mimics. Only clear criteria such as decapitation or detruncation should be used to determine death from a distance or by laypersons who are not medically trained. To present criteria that allow for accurate determination of death in mountain rescue situations, the International Commission for Mountain Emergency Medicine convened a panel of mountain rescue doctors and a forensic pathologist. These recommendations are based on a nonsystematic review of the literature including articles on determination of death and related topics. Activities in the mountains are associated with risks of accidents that can cause death. Knowledge regarding determination of death at the scene of an incident is important for medical and other mountain rescue personnel. In a mountain environment, there may be objective hazards such as rockfall, avalanches, inclement weather, bad visibility, and low partial pressure of oxygen at high altitudes, limiting the work capacity of rescuers. These affect the safety of the rescue team, which must always take priority when deciding whether a rescue should be undertaken.1Blancher M. Albasini F. Elsensohn F. Zafren K. Hölzl N. McLaughlin K. et al.Management of multi-casualty incidents in mountain rescue: evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).High Alt Med Biol. 2018; 19: 131-140Crossref PubMed Scopus (14) Google Scholar If the victim is declared dead, a rescue mission could be aborted for safety reasons, and evacuation of the body could take place later when conditions are safer. Furthermore, unnecessary medical interventions, such as futile attempts at cardiopulmonary resuscitation (CPR), could be avoided.2WHOClinical Criteria for the Determination of Death- WHO Technical Expert Consultation. Vol 2019. WHO, Geneva2014Google Scholar Determination of death can be particularly helpful in incidents with several victims or when multiple incidents occur simultaneously by allowing resources to be reallocated and rescue personnel to be assigned to other duties.3Bonnin M.J. Pepe P.E. Kimball K.T. Clark Jr., P.S. Distinct criteria for termination of resuscitation in the out-of-hospital setting.JAMA. 1993; 270: 1457-1462Crossref PubMed Scopus (194) Google Scholar Finally, the workload of the hospital team can be reduced by preventing unnecessary admissions. Death must be determined with absolute certainty. Incorrect determination of death,4Gordon L. Pasquier M. Brugger H. Paal P. Autoresuscitation (Lazarus phenomenon) after termination of cardiopulmonary resuscitation - a scoping review.Scand J Trauma Resusc Emerg Med. 2020; 28: 14Crossref PubMed Scopus (11) Google Scholar with failure to perform CPR, may lead to an avoidable death with emotional and legal consequences for the rescuers5Dettmeyer R. Verhoff M.A. Todesfeststellung und Leichenschau.Notfallmedizin up2date. 2010; 5: 77-91Crossref Google Scholar and more distress for the next of kin. We do not discuss termination of prehospital CPR that is already in progress6Millin M.G. Khandker S.R. Malki A. Termination of resuscitation of nontraumatic cardiopulmonary arrest: resource document for the National Association of EMS Physicians position statement.Prehosp Emerg Care. 2011; 15: 547-554Crossref PubMed Scopus (47) Google Scholar,7Paal P. Milani M. Brown D. Boyd J. Ellerton J. Termination of cardiopulmonary resuscitation in mountain rescue.High Alt Med Biol. 2012; 13: 200-208Crossref PubMed Scopus (43) Google Scholar or autorescuscitation (the “Lazarus phenomenon”),4Gordon L. Pasquier M. Brugger H. Paal P. Autoresuscitation (Lazarus phenomenon) after termination of cardiopulmonary resuscitation - a scoping review.Scand J Trauma Resusc Emerg Med. 2020; 28: 14Crossref PubMed Scopus (11) Google Scholar in which there is return of spontaneous circulation after termination of CPR in a patient who was considered to be dead.8Hornby K. Hornby L. Shemie S.D. A systematic review of autoresuscitation after cardiac arrest.Crit Care Med. 2010; 38: 1246-1253Crossref PubMed Scopus (126) Google Scholar,9Hornby L. Dhanani S. Shemie S.D. Update of a systematic review of autoresuscitation after cardiac arrest.Crit Care Med. 2018; 46: e268-e272Crossref PubMed Scopus (29) Google Scholar Our goals are to summarize the methods used to make a determination of death, define objective criteria that can help in this difficult task, discuss pitfalls, and provide recommendations on how to proceed in special situations that may be encountered in mountain rescue. The International Commission for Mountain Emergency Medicine convened a panel of mountain rescue doctors and a forensic pathologist. In addition to searching the internet for guidelines regarding determination of death, a nonsystematic literature search was performed in PubMed for articles related to determination of death and related topics. Abstracts of pertinent articles and reference lists of interesting articles were skimmed for further articles. Seventy-nine articles were included. There were no exclusion criteria based on article type. Only articles without relevant content were excluded. In the past, death was based on a simple determination of the cessation of heart and lung function. It was then assumed that an individual was no longer alive. The development of ventilators and other life-support methods that replace the functions of the heart and lungs has made the definition and diagnosis of death much more complicated.10Schlotzhauer A.V. Liang B.A. Definitions and implications of death.Hematol Oncol Clin North Am. 2002; 16: 1397-1413Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Internationally, death is defined as a permanent loss of capacity for consciousness and all brainstem functions, which cannot resume spontaneously and will not be restored through intervention or because of situational or environmental conditions. This can happen as a result of permanent cessation of circulation or after catastrophic brain injury.2WHOClinical Criteria for the Determination of Death- WHO Technical Expert Consultation. Vol 2019. WHO, Geneva2014Google Scholar,11Bernat J.L. How the distinction between “irreversible” and “permanent” illuminates circulatory-respiratory death determination.J Med Philos. 2010; 35: 242-255Crossref PubMed Scopus (80) Google Scholar, 12Canadian Blood ServicesInternational Guidelines for the Determination of Death – Phase I. Vol 2019. WHO, Ottawa, Ontario2012Google Scholar, 13Shemie S.D. Hornby L. Baker A. Teitelbaum J. Torrance S. Young S. et al.International guideline development for the determination of death.Intensive Care Med. 2014; 40: 788-797Crossref PubMed Scopus (154) Google Scholar In addition, a primary or secondary respiratory event can cause hypoxemia resulting in cardiac arrest and cessation of circulation to all organs including the brain.14Shemie S.D. Clarifying the paradigm for the ethics of donation and transplantation: was ‘dead’ really so clear before organ donation?.Philos Ethics Humanit Med. 2007; 2: 18Crossref PubMed Scopus (47) Google Scholar The phenomenon of death can be divided into 2 categories15Dettmeyer R.B. Verhoff M.A. Schütz H.F. Forensic Medicine. Fundamentals and Perspectives. Springer, Heidelberg, Germany2014Google Scholar:1)The absence of vital signs. This is unreliable for confirming that life has ceased.2)The presence of definitive signs of death that are sufficient to determine death. Dying can be a process that takes place over time in which biological and physiological functions gradually cease, but it also can be sudden, as in trauma.13Shemie S.D. Hornby L. Baker A. Teitelbaum J. Torrance S. Young S. et al.International guideline development for the determination of death.Intensive Care Med. 2014; 40: 788-797Crossref PubMed Scopus (154) Google Scholar,16Gardiner D. Shemie S. Manara A. Opdam H. International perspective on the diagnosis of death.Br J Anaesth. 2012; 108: i14-i28Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar Death itself is an event during this process. It is the step beyond which a cell or an organism is irreversibly committed to die17Zamperetti N. Bellomo R. Ronco C. Defining death in non-heart beating organ donors.J Med Ethics. 2003; 29: 182-185Crossref PubMed Scopus (37) Google Scholar and is the time when a person can be said to have died.13Shemie S.D. Hornby L. Baker A. Teitelbaum J. Torrance S. Young S. et al.International guideline development for the determination of death.Intensive Care Med. 2014; 40: 788-797Crossref PubMed Scopus (154) Google Scholar,18Shemie S.D. Gardiner D. Circulatory arrest, brain arrest and death determination.Front Cardiovasc Med. 2018; 5: 15Crossref PubMed Scopus (13) Google Scholar Death can sometimes be delayed or averted by life-sustaining treatment. Doctors should decide at what point in this process there is permanence and death can be appropriately declared.16Gardiner D. Shemie S. Manara A. Opdam H. International perspective on the diagnosis of death.Br J Anaesth. 2012; 108: i14-i28Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar As soon as a person has died, postmortem changes begin. The rate at which these occur can be modified by various factors. Examples of internal factors include bleeding, fever, or infections. An example of an external factor is ambient temperature. A general timeline can only roughly depict the events immediately before and after death (Figure 1). The determination or diagnosis of death describes the examination of a person to establish whether clinical features are present indicating that death has occurred. This can be one of the most difficult decisions in medical practice. It must be accomplished while avoiding diagnostic errors.16Gardiner D. Shemie S. Manara A. Opdam H. International perspective on the diagnosis of death.Br J Anaesth. 2012; 108: i14-i28Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar In a prehospital setting in a mountain environment, determination of death may be even more difficult because a physician, who is responsible for this task in most organizations, may not see the person at the scene19Robinson K.J. Murphy D.M. Jacobs L.M. Presumption of death by air medical transport teams.Air Med J. 2003; 22: 30-34Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar and because technical support, such as cardiac monitoring, may not be available. Differentiating between a newly deceased person and an apparently lifeless person who might benefit from immediate CPR can present a special challenge.5Dettmeyer R. Verhoff M.A. Todesfeststellung und Leichenschau.Notfallmedizin up2date. 2010; 5: 77-91Crossref Google Scholar,20Mikkelsen S. Lossius H.M. Binderup L.G. Schaffalitzky de Muckadell C. Toft P. Lassen A.T. Termination of pre-hospital resuscitation by anaesthesiologists - causes and consequences. A retrospective study.Acta Anaesthesiol Scand. 2017; 61: 250-258Crossref PubMed Scopus (5) Google Scholar,21Siebel A. Krempel S. Todesfeststellung und Leichenschau im Notarztdienst in Deutschland.Notarzt. 2015; 31: 39-46Crossref Scopus (2) Google Scholar Death should only be determined and resuscitation efforts withheld when it is clear that the victim has sustained irreversible cessation of circulatory and respiratory functions. In many cases, this is only possible with certainty if definitive signs of death are observed during an external inspection of the body.16Gardiner D. Shemie S. Manara A. Opdam H. International perspective on the diagnosis of death.Br J Anaesth. 2012; 108: i14-i28Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar It may take at least 20 to 30 min after death before definitive signs of death appear. Therefore, it may be almost impossible to pronounce a victim dead immediately after death. Exceptions are the presence of criteria for the termination of CPR or a catastrophic injury, such as decapitation.7Paal P. Milani M. Brown D. Boyd J. Ellerton J. Termination of cardiopulmonary resuscitation in mountain rescue.High Alt Med Biol. 2012; 13: 200-208Crossref PubMed Scopus (43) Google Scholar,22Hopson L.R. Hirsh E. Delgado J. Domeier R.M. McSwain N.E. Krohmer J. et al.Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: joint position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma.J Am Coll Surg. 2003; 196: 106-112Abstract Full Text Full Text PDF PubMed Scopus (136) Google Scholar Protocols for withholding resuscitation should be based on the determination that there are no signs of life, that injuries are obviously incompatible with life, or that there is evidence of prolonged arrest (Figure 2).23Millin M.G. Galvagno S.M. Khandker S.R. Malki A. Bulger E.M. Withholding and termination of resuscitation of adult cardiopulmonary arrest secondary to trauma: resource document to the joint NAEMSP-ACSCOT position statements.J Trauma Acute Care Surg. 2013; 75: 459-467Crossref PubMed Google Scholar Unless there is a valid do-not-resuscitate order, if there is any uncertainty about the determination of death, all feasible life-saving measures should be attempted and the patient should be transported emergently to a hospital.20Mikkelsen S. Lossius H.M. Binderup L.G. Schaffalitzky de Muckadell C. Toft P. Lassen A.T. Termination of pre-hospital resuscitation by anaesthesiologists - causes and consequences. A retrospective study.Acta Anaesthesiol Scand. 2017; 61: 250-258Crossref PubMed Scopus (5) Google Scholar,24Mohr M. Busch M. Bahr J. Kettler D. Reanimieren oder nicht? Die notärztliche Entscheidung im Rettungsdienst.Ansthesiol Intensivmed Notfallmed Schmerzther. 2003; 38: 341-348Crossref PubMed Scopus (7) Google Scholar The same applies to patients with traumatic cardiac arrest without definitive signs of death, although factors that predict failure of CPR, such as long duration of transport to a hospital and high injury severity score, are common in mountain incidents. The outcomes of CPR in trauma patients are dismal.25Konesky K.L. Guo W.A. Revisiting traumatic cardiac arrest: should CPR be initiated?.Eur J Trauma Emerg Surg. 2018; 44: 903-908Crossref PubMed Scopus (19) Google Scholar In a mountain or remote environment, a patient in cardiac arrest has an extremely poor prognosis, often because the rescue network is too thinly stretched.26Strohle M. Paal P. Strapazzon G. Avancini G. Procter E. Brugger H. Defibrillation in rural areas.Am J Emerg Med. 2014; 32: 1408-1412Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar For example, in a retrospective study from Austria, only 3% of patients with primary cardiac arrest in the mountains survived to hospital discharge.27Strohle M. Vogele A. Neuhauser P. Rauch S. Brugger H. Paal P. Sudden cardiac arrest and cardiopulmonary resuscitation with automated external defibrillator in the Austrian mountains: a retrospective study.High Alt Med Biol. 2019; 20: 392-398Crossref PubMed Scopus (3) Google Scholar Similarly, a study from Korea assessing patients who had sustained nontraumatic out-of-hospital cardiac arrest while exercising in a national or provincial mountain park found that outcomes were worse compared to patients in cardiac arrest in other locations.28Jung E. Park J.H. Kong S.Y. Hong K.J. Ro Y.S. Song K.J. et al.Cardiac arrest while exercising on mountains in national or provincial parks: a national observational study from 2012 to 2015.Am J Emerg Med. 2018; 36: 1350-1355Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar If an apparently lifeless person is found and it is not obvious that the person is dead, rescuers should check for signs of life. Breathing and pulse may be faint and very hard to detect, especially in a hypothermic patient.29Pasquier M. Zurron N. Weith B. Turini P. Dami F. Carron P.N. et al.Deep accidental hypothermia with core temperature below 24°C presenting with vital signs.High Alt Med Biol. 2014; 15: 58-63Crossref PubMed Scopus (49) Google Scholar Rescuers should suspect special circumstances, such as severe hypothermia, when a cardiac arrest occurs in the mountains and should check for signs of life for up to 1 min.30Truhlar A. Deakin C.D. Soar J. Khalifa G.E.A. Alfonzo A. Bierens J.J.L.M. et al.European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances.Resuscitation. 2015; 95: 148-201Abstract Full Text Full Text PDF PubMed Scopus (586) Google Scholar If electrocardiography or point of care ultrasound are available, rescuers should look for signs of cardiac activity. A hypothermic patient in cardiac arrest is not dead unless warm and dead, unless there are definitive signs of death. A conscious person responds purposefully to voice, touch, or painful or other noxious stimuli, such as a sternal rub. An unconscious person may not respond but nevertheless can still be hemodynamically stable. The rescuer should open the airway by extending the neck and lifting the chin, or by using a jaw thrust if there is a concern about a possible high spinal injury. The rescuer should look for chest movement or place a hand flat on the chest to feel for small chest rises. If the rescuer places an ear close to the patient’s mouth, breath sounds may be audible or air movements may be sensed. If a stethoscope is available, the rescuer should listen for breath sounds over the trachea. Another technique is to hold goggles over the nose and mouth to look for misting. Absence of misting does not indicate absence of respiration. The rescuer should allow 1 min to check in case the person is breathing very slowly, possibly as slowly as once every 10 to 15 s.29Pasquier M. Zurron N. Weith B. Turini P. Dami F. Carron P.N. et al.Deep accidental hypothermia with core temperature below 24°C presenting with vital signs.High Alt Med Biol. 2014; 15: 58-63Crossref PubMed Scopus (49) Google Scholar Breathing is often easier to detect than a pulse, although slight respiratory movements can be overlooked with thick clothing. Circulation is present if regular breathing is present, rather than gasping or agonal (occasional) breaths. Point of care ultrasound or measurement of end-tidal CO2 may also be useful, if available. A pulse may be felt where large arteries lie close to the skin. In adults and children, the best locations are the carotid arteries at either side of the neck or the femoral arteries in the groin. In infants, the brachial and femoral arteries are easiest.31Maconochie I.K. Bingham R. Eich C. Lopez-Herce J. Rodriguez-Nunez A. Rajka T. et al.European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support.Resuscitation. 2015; 95: 223-248Abstract Full Text Full Text PDF PubMed Scopus (292) Google Scholar If a stethoscope is available, the rescuer should attempt to check for heart sounds, although these may be faint. If available, cardiac monitoring can be very valuable for assessing the presence of cardiac electrical activity and for checking the rhythm. As with breathing, the pulse can be weak and very slow (bradycardic), with a heartbeat only every few seconds, and very difficult to detect. A low-output circulatory state can be present, even when a pulse is not palpable.16Gardiner D. Shemie S. Manara A. Opdam H. International perspective on the diagnosis of death.Br J Anaesth. 2012; 108: i14-i28Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar In severe hypothermia, there may be a very slow, small-volume, irregular pulse that is not palpable, and blood pressure may be undetectable.30Truhlar A. Deakin C.D. Soar J. Khalifa G.E.A. Alfonzo A. Bierens J.J.L.M. et al.European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances.Resuscitation. 2015; 95: 148-201Abstract Full Text Full Text PDF PubMed Scopus (586) Google Scholar Any active movement of joints must be considered a sign of life. Active movements must be distinguished from passive movements caused by touching the body or changing the position of the body because of gravity in rough terrain. Gasping is considered to be a sign of recent cardiac arrest and should trigger CPR.32Perkins G.D. Travers A.H. Berg R.A. Castren M. Considine J. Escalante R. et al.Part 3: adult basic life support and automated external defibrillation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.Resuscitation. 2015; 95: e43-69Abstract Full Text Full Text PDF PubMed Scopus (171) Google Scholar Pupillary response is tested by shining a light in the eyes. Pupils normally constrict with direct illumination (direct response) and with illumination of the opposite eye (consensual response). In patients with intracranial pathology, bilateral fixed and dilated pupils (large pupils that do not respond to light) can indicate brainstem damage with a poor prognosis or can be caused by drug use. Especially in severe hypothermia, drowning, or lightning injury, fixed and dilated pupils are not reliable signs of death. Temperature measured with a probe in the lower third of the esophagus correlates well with the core temperature of the body.33Strapazzon G. Procter E. Paal P. Brugger H. Pre-hospital core temperature measurement in accidental and therapeutic hypothermia.High Alt Med Biol. 2014; 15: 104-111Crossref PubMed Scopus (55) Google Scholar Epitympanic temperature may be falsely low if the environment is very cold, the probe is not well insulated, or the external auditory canal is filled with wax, snow, or water.33Strapazzon G. Procter E. Paal P. Brugger H. Pre-hospital core temperature measurement in accidental and therapeutic hypothermia.High Alt Med Biol. 2014; 15: 104-111Crossref PubMed Scopus (55) Google Scholar,34Walpoth B.H. Galdikas J. Leupi F. Muehlemann W. Schlaepfer P. Althaus U. Assessment of hypothermia with a new “tympanic” thermometer.J Clin Monit. 1994; 10: 91-96Crossref PubMed Scopus (44) Google Scholar Vital signs may be present below a core temperature of 24°C.29Pasquier M. Zurron N. Weith B. Turini P. Dami F. Carron P.N. et al.Deep accidental hypothermia with core temperature below 24°C presenting with vital signs.High Alt Med Biol. 2014; 15: 58-63Crossref PubMed Scopus (49) Google Scholar The lowest core temperatures from which patients have been successfully resuscitated are 4.2°C for induced hypothermia35Stephen C.R. Dent S.J. Hall K.D. Smith W.W. Physiologic reactions during profound hypothermia with cardioplegia.Anesthesiology. 1961; 22: 873-881Crossref PubMed Scopus (12) Google Scholar and 11.8°C for accidental hypothermia.35Stephen C.R. Dent S.J. Hall K.D. Smith W.W. Physiologic reactions during profound hypothermia with cardioplegia.Anesthesiology. 1961; 22: 873-881Crossref PubMed Scopus (12) Google Scholar,36Darocha T. Podsiadlo P. Polak M. Hymczak H. Krzych L. Skalski J. et al.Prognostic factors for nonasphyxia-related cardiac arrest patients undergoing extracorporeal rewarming - HELP Registry Study.J Cardiothorac Vasc Anesth. 2020; 34: 365-371Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Core temperature should not, by itself, be used to determine death or withhold resuscitation.37Zafren K. Paal P. Brugger H. Lechner R. Induced hypothermia to 4.2°C with neurologically intact survival: a forgotten case series.Wilderness Environ Med. 2020; ([Epub ahead of print)Abstract Full Text Full Text PDF Scopus (2) Google Scholar Absence of vital signs is not pathognomonic of death because signs may be absent although a person is still alive. In some situations, a person can have no vital signs but can be resuscitated. Reversible causes of cardiac arrest include the “Hs” (hypovolemia, hypoxia, hydrogen ion [acidosis], hypo- or hyperkalemia, hypothermia, and hypoglycemia) and “Ts” (tension pneumothorax, tamponade [pericardiac], toxins, thrombosis [coronary or pulmonary], and trauma) of advanced cardiac life support.38Panchal A.R. Berg K.M. Kudenchuk P.J. Del Rios M. Jirsch K.G. Link M.S. et al.2018 American Heart Association focused update on advanced cardiovascular life support use of antiarrhythmic drugs during and immediately after cardiac arrest: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2018; 138: e740-e749PubMed Google Scholar,39Perkins G.D. Olasveengen T.M. Maconochie I. Soar J. Wyllie J. Greif R. et al.European Resuscitation Council Guidelines for Resuscitation: 2017 update.Resuscitation. 2018; 123: 43-50Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar In the prehospital setting, there are limited opportunities to obtain information about a patient’s status using technological methods. In addition to cardiac monitoring, point of care echocardiography may be useful to diagnose cardiac arrest.38Panchal A.R. Berg K.M. Kudenchuk P.J. Del Rios M. Jirsch K.G. Link M.S. et al.2018 American Heart Association focused update on advanced cardiovascular life support use of antiarrhythmic drugs during and immediately after cardiac arrest: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2018; 138: e740-e749PubMed Google Scholar Other technical methods, or measurements of physiologic parameters such as end tidal (exhaled) carbon dioxide (ETCO2) and serum potassium, have no role in determining death in a prehospital setting. High and increasing ETCO2 values are associated with increased rates of return of spontaneous circulation and survival after CPR. Low ETCO2 alone should not be used to decide whether CPR can be stopped. Similarly, absence of ETCO2 alone should not be used to determine death.40Sandroni C. De Santis P. D’Arrigo S. Capnography during cardiac arrest.Resuscitation. 2018; 132: 73-77Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Low serum potassium can only be used as a factor in rewarming decisions in hypothermia.30Truhlar A. Deakin C.D. Soar J. Khalifa G.E.A. Alfonzo A. Bierens J.J.L.M. et al.European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances.Resuscitation. 2015; 95: 148-201Abstract Full Text Full Text PDF PubMed Scopus (586) Google Scholar,41Dobson J.A. Burgess J.J. Resuscitation of severe hypothermia by extracorporeal rewarming in a child.J Trauma. 1996; 40: 483-485Crossref PubMed Scopus (65) Google Scholar, 42Touma O. Davies M. The prognostic value of end tidal carbon dioxide during cardiac arrest: a systematic review.Resuscitation. 2013; 84: 1470-1479Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar, 43Brugger H. Durrer B. Elsensohn F. Paal P. Strapazzon G. Winterberger E. et al.Resuscitation of avalanche victims: evidence-based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM): intended for physicians and other advanced life support personnel.Resuscitation. 2013; 84: 539-546Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar, 44Romlin B.S. Winberg H. Janson M. Nilsson B. Björk K. Jeppsson A. et al.Excellent outcome with extracorporeal membrane oxygenation after accidental profound hypothermia (13.8°C) and drowning.Crit Care Med. 2015; 43: e521-e525Crossref PubMed Scopus (35) Google Scholar, 45Paal P. Gordon L. Strapazzon G. Maeder M.B. Putzer G. Walpoth B. et al.Accidental hypothermia-an update: the content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).Scand J Trauma Resusc Emerg Med. 2016; 24: 111Crossref PubMed Scopus (126) Google Scholar In cold conditions, which are common in the mountains, electronic devices often fail. A meticulous clinical examination is therefore mandatory. Many conditions are diagnostic of death (Table 1). When at least 1 of these conditions is present, initiation of CPR is contraindicated.5Dettmeyer R. Verhoff M.A. Todesfeststellung und Leichenschau.Notfallmedizin up2date. 2010; 5: 77-91Crossref Google Scholar,16Gardiner D. Shemie S. Manara A. Op" @default.
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• W3092870017 title "Determination of Death in Mountain Rescue: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom)" @default.
• W3092870017 cites W1429287235 @default.
• W3092870017 cites W1568571733 @default.
• W3092870017 cites W1950209333 @default.
• W3092870017 cites W1963766098 @default.
• W3092870017 cites W1963803938 @default.
• W3092870017 cites W1968228247 @default.
• W3092870017 cites W1972359325 @default.
• W3092870017 cites W1973121529 @default.
• W3092870017 cites W1977440836 @default.
• W3092870017 cites W1978624770 @default.
• W3092870017 cites W1985276529 @default.
• W3092870017 cites W1986849060 @default.
• W3092870017 cites W1990299277 @default.
• W3092870017 cites W1994822427 @default.
• W3092870017 cites W1999033135 @default.
• W3092870017 cites W2005925820 @default.
• W3092870017 cites W2030550756 @default.
• W3092870017 cites W2037906603 @default.
• W3092870017 cites W2041495090 @default.
• W3092870017 cites W2048036494 @default.
• W3092870017 cites W2057856010 @default.
• W3092870017 cites W2070366986 @default.
• W3092870017 cites W2074745497 @default.
• W3092870017 cites W2078122542 @default.
• W3092870017 cites W2081869197 @default.
• W3092870017 cites W2082521830 @default.
• W3092870017 cites W2093181913 @default.
• W3092870017 cites W2094003358 @default.
• W3092870017 cites W2095562355 @default.
• W3092870017 cites W2097647329 @default.
• W3092870017 cites W2097879884 @default.
• W3092870017 cites W2100834444 @default.
• W3092870017 cites W2102318762 @default.
• W3092870017 cites W2114377642 @default.
• W3092870017 cites W2115657636 @default.
• W3092870017 cites W2123296163 @default.
• W3092870017 cites W2128409773 @default.
• W3092870017 cites W2141331763 @default.
• W3092870017 cites W2141739642 @default.
• W3092870017 cites W2147099718 @default.
• W3092870017 cites W2152073026 @default.
• W3092870017 cites W2163925232 @default.
• W3092870017 cites W2254703365 @default.
• W3092870017 cites W2282854717 @default.
• W3092870017 cites W2290836127 @default.
• W3092870017 cites W2322576837 @default.
• W3092870017 cites W2347202469 @default.
• W3092870017 cites W2522765900 @default.
• W3092870017 cites W2554858830 @default.
• W3092870017 cites W2578872263 @default.
• W3092870017 cites W2770948521 @default.
• W3092870017 cites W2771148358 @default.
• W3092870017 cites W2777885923 @default.
• W3092870017 cites W2781241153 @default.
• W3092870017 cites W2789571849 @default.
• W3092870017 cites W2793537240 @default.
• W3092870017 cites W2888192440 @default.
• W3092870017 cites W2901350579 @default.
• W3092870017 cites W2902181114 @default.
• W3092870017 cites W2902482209 @default.
• W3092870017 cites W2917840625 @default.
• W3092870017 cites W2964377673 @default.
• W3092870017 cites W2981119317 @default.
• W3092870017 cites W2994462160 @default.
• W3092870017 cites W3012764693 @default.
• W3092870017 cites W3032028383 @default.
• W3092870017 cites W4211105390 @default.
• W3092870017 cites W4248715599 @default.
• W3092870017 cites W4252078847 @default.
• W3092870017 doi "https://doi.org/10.1016/j.wem.2020.06.013" @default.
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