Pharmacological Prophylaxis and Supplemental Oxygen for Unacclimatized Rescuers at Very High Altitude: Scoping Review and 2025 Joint Recommendations of the International Commission for Mountain Emergency Medicine and the International Society for Mountain Medicine
Bibliographic record
Abstract
McLaughlin, Kyle, Steve Roy, Marika Falla, Giacomo Strapazzon, Andrew M. Luks, Ken Zafren, Hermann Brugger, Martin Musi, Iztok Tomazin, John Ellerton, Ghan Bahadur Thapa, and Peter Paal. Pharmacological prophylaxis and supplemental oxygen for unacclimatized rescuers at very high altitude: scoping review and 2025 joint recommendations of the International Commission for Mountain Emergency Medicine and the International Society for Mountain Medicine. High Alt Med Biol. 27:60–77, 2026. Background: Mountain rescuers and pilots rapidly ascending to altitudes above 3,500 m are exposed to the detrimental effects of hypobaric hypoxia, including cognitive and physical impairment, as well as high-altitude illness (HAI). We conducted a scoping review of oxygen supplementation and pharmacologic measures to improve cognitive and physical performance and prevent HAI in unacclimatized rescuers rapidly ascending above 3,500 m during rescue missions. Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, 723 articles were screened, 133 reviewed and a total of 50 articles were included for data extraction, based on the intervention: 6 on oxygen, 29 on acetazolamide (AZ), 17 on dexamethasone (DEX), 3 on nifedipine, and 5 on phosphodiesterase-5 inhibitors. Discussion: Supplemental oxygen improves physical and cognitive performance at high altitude and is recommended for rapid ascent rescues >30 minutes between 3,500 and 4,000 m, and for rescues of any duration above 4,000 m. If oxygen is administered, pharmacological prophylaxis is not required. If oxygen is unavailable, AZ or DEX can be used for rapid ascent rescues above 3,500 m for longer than 3 hours to reduce the incidence and severity of acute mountain sickness. At altitudes above 5,000 m or for rescues requiring prolonged physical work, the use of both AZ and DEX is recommended. Conclusions: To enhance the safety and effectiveness of high-altitude rescues, we provide recommendations for the use of supplemental oxygen and pharmacologic prophylaxis to reduce the risk of HAI and improve cognitive and physical performance during rapid ascents to altitudes >3,500 m.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.029 | 0.070 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.010 |
| Bibliometrics | 0.014 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".