Original Research|Articles in Press

Sudden Cardiac Arrests in the Polish Tatra Mountains: A Retrospective Study

Published:January 27, 2023DOI:


      Achieving the optimal survival rate for sudden cardiac arrest in mountains is challenging. The odds of surviving are influenced mainly by distance, response time, and organization of the emergency medical system. The aim of this study was to analyze the epidemiology and outcomes of patients with out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation was performed in the Polish Tatra Mountains.


      This was a retrospective analysis of data on sudden cardiac arrest collected from the database of the Tatra Mountain Rescue Service and local emergency medical system from 2001 to 2021.


      A total of 74 cases of sudden cardiac arrest were recorded. The mortality rate was 88% (65/74). Return of spontaneous circulation was achieved in 22 (30%) patients. A group of survivors was characterized by more frequent use of an automated external defibrillator (AED) (56% vs 14%, P=0.011), a shorter interval between cardiac arrest and emergency team arrival (12 vs 20 min, P=0.005), and a shorter time to initiation of advanced life support (ALS) (12 vs 22 min, P=0.004). All survivors had a shockable initial rhythm. The majority of survivors (8/9, 89%) had a good or moderate neurological outcome.


      This study confirms poor survival rate after sudden cardiac arrest in the mountain area. The use of AED, shockable initial rhythm, and shorter time interval to emergency team arrival and ALS initiation are associated with better outcomes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Wilderness & Environmental Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Burtscher M.
        • Pachinger O.
        • Schocke M.F.
        • Ulmer H.
        Risk factor profile for sudden cardiac death during mountain hiking.
        Int J Sports Med. 2007; 28: 621-624
        • Eisenburger P.
        • Czappek G.
        • Sterz F.
        • Vergeiner G.
        • Losert H.
        • Holzer M.
        • et al.
        Cardiac arrest patients in an alpine area during a six year period.
        Resuscitation. 2001; 51: 39-46
        • Ströhle M.
        • Vögele 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: 392-398
        • Sumann G.
        • Moens D.
        • Brink B.
        • Brodmann Maeder M.
        • Greene M.
        • Jacob M.
        • et al.
        Multiple trauma management in mountain environments — a scoping review: evidence based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Intended for physicians and other advanced life support personnel.
        Scand J Trauma Resusc Emerg Med. 2020; 28: 117
        • Viglino D.
        • Maignan M.
        • Michalon A.
        • Turk J.
        • Buse S.K.
        • Blancher M.
        • et al.
        Survival of cardiac arrest patients on ski slopes: a 10-year analysis of the Northern French Alps Emergency Network.
        Resuscitation. 2017; 119: 43-47
        • Burtscher M.
        • Philadelphy M.
        • Likar R.
        Sudden cardiac death during mountain hiking and downhill skiing.
        N Engl J Med. 1993; 329: 1738-1739
        • Masterson S.
        • Wright P.
        • O’Donnell C.
        • Vellinga A.
        • Murphy A.W.
        • Hennelly D.
        • et al.
        Urban and rural differences in out-of-hospital cardiac arrest in Ireland.
        Resuscitation. 2015; 91: 42-47
        • Pell J.P.
        • Sirel J.M.
        • Marsden A.K.
        • Ford I.
        • Cobbe S.M.
        Effect of reducing ambulance response times on deaths from out of hospital cardiac arrest: cohort study.
        BMJ. 2001; 322: 1385-1388
        • Jennett B.
        • Bond M.
        Assessment of outcome after severe brain damage.
        Lancet. 1975; 1: 480-484
        • Berdowski J.
        • Berg R.A.
        • Tijssen J.G.
        • Koster R.W.
        Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies.
        Resuscitation. 2010; 81: 1479-1487
        • Gräsner J.T.
        • Wnent J.
        • Herlitz J.
        • Perkins G.D.
        • Lefering R.
        • Tjelmeland I.
        • et al.
        Survival after out-of-hospital cardiac arrest in Europe — results of the EuReCa TWO study.
        Resuscitation. 2020; 148: 218-226
        • Elsensohn F.
        • Agazzi G.
        • Syme D.
        • Swangard M.
        • Facchetti G.
        • Brugger H.
        • et al.
        The use of automated external defibrillators and public access defibrillators in the mountains: official guidelines of the international commission for mountain emergency medicine ICAR-MEDCOM.
        Wilderness Environ Med. 2006; 17: 64-66
        • Lott C.
        • Truhlář A.
        • Alfonzo A.
        • Barelli A.
        • González-Salvado V.
        • Hinkelbein J.
        • et al.
        European Resuscitation Council Guidelines 2021: cardiac arrest in special circumstances.
        Resuscitation. 2021; 161: 152-219
        • Semeraro F.
        • Greif R.
        • Böttiger B.W.
        • Burkart R.
        • Cimpoesu D.
        • Georgiou M.
        • et al.
        European Resuscitation Council Guidelines 2021: systems saving lives.
        Resuscitation. 2021; 161: 80-97
        • Stiell I.G.
        • Wells G.A.
        • Field B.
        • Spaite D.W.
        • Nesbitt L.P.
        • De Maio V.J.
        • et al.
        Advanced cardiac life support in out-of-hospital cardiac arrest.
        N Engl J Med. 2004; 351: 647-656
        • Kurz M.C.
        • Schmicker R.H.
        • Leroux B.
        • Nichol G.
        • Aufderheide T.P.
        • Cheskes S.
        • et al.
        Advanced vs. basic life support in the treatment of out-of-hospital cardiopulmonary arrest in the resuscitation outcomes consortium.
        Resuscitation. 2018; 128: 132-137
        • Soteras I.
        • Paal P.
        • Ayala M.
        • Carmona F.
        • Subirats E.
        • Strapazzon G.
        In response to cardiac events in mountain rescues in Aragón by Martínez-Caballero et al.
        Wilderness Environ Med. 2020; 31: 118-119