HAPE, ASCENDING TOO FAST, INEXPERIENCE

Alaska, Mount McKinley

On May 28, 1988, High Altitude Medical Project personnel received a report from another expedition that Masako Yamakoshi (39), a female member of a Japanese climbing team, was ill at the 4300 meter basin on the West Buttress route. Medical personnel contacted the Japanese AWAF McKinley Expedition team, but were told the woman was fine, so they returned to the research facility without examining her. The next day the medical team received additional reports that the woman needed medical assistance. Again they approached the Japanese team and this time insisted upon examining her. They discovered Yamakoshi to be in the advanced stages of HAPE. She had typical symptoms of HAPE: cough, weakness, fatigue, fast heart rate and shortness of breath. Her oxygen saturation level was 41%. (A normal oxygen saturation level at 4300 meters is 80%.) Yamakoshi was too weak to descend so she was placed on oxygen breathing for the night and administered Diamox.

The following day, her oxygen saturation had improved somewhat. However, no one in her party was strong enough to help her descend. In fact, part of the expedition had left for the summit leaving two other ill members plus Yamakoshi at the 4300 meter basin. Both of these members also were suffering from HAPE! The following day, after spending 60 hours on oxygen and Diamox, Yamakoshi was strong enough to descend under her own power, but there were still not enough members of her expedition to allow a safe descent. On June 3, U.S. Army Chinook helicopters flew into the basin to assist in another rescue. Medical camp personnel requested she be flown back to Talkeetna with those helicopters, arriving in Talkeetna at 1100. (Source: Bob Seibert, Mountaineering Ranger, Denali National Park)

Analysis

Ranger Seibert pointed out that while this team took five to six days to ascend from 2100 meters to 4300 meters, it was still too fast for at least three of the members.

This was a fairly typical case of HAPE, of which there were 12 life-threatening episodes this season. The characteristic symptoms of weakness, fatigue, shortness of breath, fast breathing rate and fast heart rate, and dry cough are diagnostic and any of these symptoms even alone should never be ignored. This group did not recognize HAPE until late in its course, and in fact, they had a total of three members with severe pulmonary edema. If we had not insisted that she be checked, she may well have been left alone and found dead the next morning. She was much too ill to attempt a descent herself and her team was too weak to take her down. Oxygen breathing saved her life and eventually completely resolved the HAPE. Descent would probably have been a quicker cure, but was not practical.

We no longer use helicopters for descent in pulmonary edema, since we can always get someone down the mountain by sled or on their own power after improvement with oxygen use. In this case, when she was quite able to descend on her own, the helicopters arrived on another mission, and she chose to fly down. Since climbers cannot predict susceptibility to pulmonary edema unless previously stricken, every climber must be aware of the early symptoms in order to make the diagnosis early. At that point, descent of only 300 to 1000 meters will invariably reverse the process and result in a complete cure; reascent can be accomplished after two or three days of rest.

Diamox may be helpful, especially in early cases of pulmonary edema, but is no substitute for descent. A pressure chamber may help as a temporizing measure, but is not as effective as high flow oxygen, and should not delay descent. (Source: Dr. Peter Hackett, Director, Denali Medical Research Project)