Resuscitation 119 (2017) 43–47 Contents lists available at ScienceDirect Resuscitation jou rn al hom ep age : w ww.elsevier.com/locate/resuscitation Clinical paper Survival of cardiac arrest patients on ski slopes: A 10-year analysis of the Northern French Alps Emergency Network  Damien Viglino a,b,∗ , Maxime Maignan a,b , Arnaud Michalon c , Julien Turk d , Sarah K. Buse a , Marc Blancher a , Tom P. Aufderheide e , Loïc Belle f , Dominique Savary c , Franc ¸ ois-Xavier Ageron c , Guillaume Debaty a,g , the Northern French Alps Emergency Network RENAU group a University Grenoble Alps – Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France b University Grenoble Alps – HP2 Laboratory INSERM U1042, Grenoble, France c Annecy-Genevois Hospital, Emergency Department and Mobile Intensive Care Unit, Annecy, France d Chambery Metropole Savoie Hospital, Emergency Department and Mobile Intensive Care Unit, Chambery, France e Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States f Annecy-Genevois Hospital, Cardiac Intensive Care Unit, Annecy, France g University Grenoble Alps − TIMC-IMAG laboratory Team PRETA CNRS UMR 5525, Grenoble, France a r t i c l e i n f o Article history: Received 1 June 2017 Received in revised form 20 July 2017 Accepted 28 July 2017 Keywords: Cardiac arrest Skiing Death Sudden Cardiac Altitude Emergency medical services a b s t r a c t Aim: Intense physical activity, cold and altitude make mountain sports a cause of increased risk of out- of-hospital cardiac arrest (OHCA). The difficulties of pre-hospital management related to this challenging environment could be mitigated by the presence of ski-patrollers in ski areas and use of helicopters for medical rescue. We assess whether this particular situation positively impacts the chain of survival compared to the general population. Methods: Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2004 to 2014. Results: 19,341 OHCAs were recorded during the period, including 136 on-slope events. Compared to other OHCAs, on-slope patients were younger (56 [40–65] vs. 66 [52–79] years, p < 0.001) and more often in shockable initial rhythm (41.2% vs 20.1%, p < 0.001). Resuscitation was more frequently started by a witness (43.4% vs 26.8%, p < 0.001) and the time to the first electric shock was shorter (7.5 min vs 14 min, p < 0.001), whereas time to the advanced life support (ALS) rescue arrival did not differ. The 30-day survival rate was higher for on-slope arrests (21.3% vs 5.9%, p < 0.001, RR = 3.61). In multivariate analysis, on-slope CA remained a positive 30-day survival factor with a 2.6 odds ratio (95% confidence interval, 1.42–4.81, p = 0.002). Conclusion: Despite difficult access and management conditions, patients undergoing OHCAs on ski slopes presented a higher survival rate, possibly explained by a healthier population, the efficiency of resusci- tation by ski-patrols and similar time to ALS facilities compared to other cardiac arrests. © 2017 Elsevier B.V. All rights reserved. 1 Introduction Out-of-hospital cardiac arrest (OHCA), with an incidence of 20–140/100,000 people per year, accounts for approximately 500,000 events per year in the United States and 430,000 in Europe,  A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi:10.1016/j.resuscitation.2017.07.030. ∗ Corresponding author at: Service des Urgences Adultes, CHU Michallon, BP 217, 38043 Grenoble Cedex 09, France. E-mail address: dviglino@chu-grenoble.fr (D. Viglino). with less than 15% survival [1,2]. With more than 100 million vis- itors per year worldwide, winter sports resorts are not spared [3]. OHCAs account for 30% of mountain deaths, i.e. one for 780,000 ski hours [4]. The relative risk of CA in skiers over 34 years of age is dou- ble the rate in the general population [5]. This increased risk can be explained by both a particular population and favourable environ- mental and circumstantial conditions. More than 90% of CAs occur in men [6], with coronary history the main risk factor [7]. The high altitude and its association with hypoxemia can trigger myocar- dial injury [3]. The addition of physical exercise in this population http://dx.doi.org/10.1016/j.resuscitation.2017.07.030 0300-9572/© 2017 Elsevier B.V. All rights reserved.