{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T18:47:27Z","timestamp":1781808447998,"version":"3.54.5"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi230413-4\"><jats:title>Importance<\/jats:title><jats:p>Approximately 70% of individuals critically buried in avalanche debris die within 35 minutes as a result of asphyxial cardiac arrest. An artificial air-pocket device (AAPD) that separates inhaled air from exhaled air may delay the onset of severe hypoxemia and eventual asphyxia during snow burial.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230413-5\"><jats:title>Objective<\/jats:title><jats:p>To investigate the efficacy of a new AAPD during snow burial in a supine position.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230413-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This comparative effectiveness trial was performed in winter 2016 with data analysis in November 2016 and November 2022. Each trial used a simulated critical avalanche burial scenario, in which a trough was dug in a snow pile and an additional air pocket of 0.5 L volume was punched into the lateral wall for each control trial. All participants were buried in a supine position. Trials could be voluntarily terminated at any time, with a maximum length of 60 minutes; trials were automatically terminated if the participant\u2019s peripheral oxygen saturation (Sp<jats:sc>o<\/jats:sc><jats:sub>2<\/jats:sub>) dropped to less than 84%.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230413-7\"><jats:title>Exposures<\/jats:title><jats:p>Each participant conducted 2 trials, one in which they breathed into the AAPD (intervention trial) and the other in which they breathed into the prepared air pocket (control trial).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230413-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Measurements included Sp<jats:sc>o<\/jats:sc><jats:sub>2<\/jats:sub>, cerebral oxygenation, ventilatory parameters, respiratory gas concentrations, and visual-analogue scales. Kaplan-Meier survival curves and rank test for matched survival data were used to analyze the total burial time in each trial.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230413-9\"><jats:title>Results<\/jats:title><jats:p>A total of 13 volunteers (9 men; mean [SD] age, 33 [8] years) were exposed to the intervention and control trials. Intervention trials were terminated less often (2 of 13 trials) as a result of hypoxemia than control trials (11 of 12 trials). Similarly, survival curves showed a longer duration of burial in the intervention compared with the control trials for the time to reach an Sp<jats:sc>o<\/jats:sc><jats:sub>2<\/jats:sub> less than 84% (rank test for matched survival data: <jats:italic>P<\/jats:italic>\u2009=\u2009.003). The intervention trials, compared with the control trials, also had slower rates of decrease in fraction of inspired oxygen (mean [SD] rate, \u22120.8 [0.4] %\/min vs \u22122.2 [1.2] %\/min) and of increase in fraction of inspired carbon dioxide (mean [SD] rate, 0.5 [0.3] %\/min vs 1.4 [0.6] %\/min) and expired ventilation per minute (mean [SD] rate, 0.5 [1.0] L\/min<jats:sup>2<\/jats:sup> vs 3.9 [2.6] L\/min<jats:sup>2<\/jats:sup>).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230413-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This comparative effectiveness trial found that the new AAPD was associated with delaying the development of hypoxemia and hypercapnia in supine participants in a critical burial scenario. Use of the AAPD may allow a longer burial time before asphyxial cardiac arrest, which might allow longer times for successful rescue by companions or by prehospital emergency medical services.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.13376","type":"journal-article","created":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T15:39:43Z","timestamp":1684165183000},"page":"e2313376","source":"Crossref","is-referenced-by-count":9,"title":["Comparative Effectiveness of an Artificial Air Pocket Device to Delay Asphyxiation in Supine Individuals Critically Buried in Avalanche Debris"],"prefix":"10.1001","volume":"6","author":[{"given":"Giacomo","family":"Strapazzon","sequence":"first","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy"},{"name":"Corpo Nazionale Soccorso Alpino e Speleologico, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Rauch","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy"},{"name":"Department of Anesthesia and Intensive Care Medicine, F. Tappeiner Hospital, Merano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Malacrida","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Dal Cappello","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrica","family":"Governo","sequence":"additional","affiliation":[{"name":"Mountain Medicine Center, Azienda Sanitaria Valle d\u2019Aosta, Aosta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna","family":"Catuzzo","sequence":"additional","affiliation":[{"name":"Mountain Medicine Center, Azienda Sanitaria Valle d\u2019Aosta, Aosta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Mrakic-Sposta","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology, National Research Council, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margherita","family":"Urgesi","sequence":"additional","affiliation":[{"name":"Mountain Medicine Center, Azienda Sanitaria Valle d\u2019Aosta, Aosta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marika","family":"Falla","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy"},{"name":"Center for Mind\/Brain Sciences, University of Trento, Rovereto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Cavoretto","sequence":"additional","affiliation":[{"name":"Mountain Medicine Center, Azienda Sanitaria Valle d\u2019Aosta, Aosta, 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