Achieving impossible heights

With Peter Habeler, Reinhold Messner made the first oxygenless ascent of Everest in 1978. Messner later became the first man to climb all fourteen of the world’s giant 8000-meter peaks. In 1980 he climbed Everest solo – without oxygen – in a blitzkrieg expedition lasting only three days. Messner’s ground-breaking climbing feats exceeded many people’s conceptions of the limits of what human physiology and the human spirit are capable of.

So, what are the unique qualities that allow elite alpinists to achieve these superhuman feats?

Dr O. Oelz, himself an Everest summiter, and his colleagues studied the physiology of six elite climbers, including Messner and Habeler, to try to answer this question in their 1986 paper:

Oelz O, Howald H, Di Prampero PE, Hoppeler H, Claassen H, Jenni R, Bühlmann A, Ferretti G, Brückner JC, Veicsteinas A, et al. Physiological profile of world-class high-altitude climbers. J Appl Physiol. 1986 May;60(5):1734-42. [Reference]

This is what they found:

  • Muscle fibers were 70% type I (slow-contracting fatigue-resistant fibres), less than for long-distance runners.
  • Mean muscle fiber cross-sectional area was smaller than sedentary controls and long-distance runners.
  • Mitochondrial volume was the same as sedentary controls, but its subsarcolemmal component was equal to that of long-distance runners.
  • Maximal oxygen consumption was 60 ml/kg/min, between that of sedentary controls and long-distance runners.
  • Maximal anaerobic power was 28 W/kg, the same as sedentary controls but lower than competitive high jumpers (-40%).
  • Ventilatory response to four tidal volumes of pure oxygen, as well as static and dynamic lung volumes, and echocardiographic measurements were all the same as sedentary controls.

There were some physiological differences that might be advantageous to extreme alpinists:

  • The number of capillaries per unit cross-sectional area was greater than sedentary controls (+ 40%).
  • All of the elite climbers showed resting hyperventilation both in normoxia and in moderate hypoxia (inspired oxygen partial pressure = 77 mmHg) resulting in higher oxyhemoglobin saturation levels in hypoxia.

But, all in all, what did their study show?

According to John B. West, author of “High life: A history of high-altitude physiology and medicine“:

… elite, extreme-altitude climbers do not have readily identifiable physiological adaptations that can explain their unique performance. Exceptional motivation and an incredible obsession to succeed may be more important factors.

I’m sure Mark Twight, author of “Extreme Alpinism: Climbing Light, Fast, and High“, would agree:

Where does this strong will and hardness come from? It comes from recognizing desires and goals and then enduring whatever it takes to fulfill them. A strong will grows from suffering and then being rewarded for it…

Suffering provides the opportunity to exercise will and to develop toughness…

Austrian climber Hermann Buhl carried snowballs in his hands to develop tolerance (psychological) and to increase capillary capacity (physical). He climbed the local crags all winter long, even in storms, and bicycled for hundreds of kilometres on his way to the mountains. It all paid off when he climbed alone to the summit of Nanga Parbat – history’s only solo first ascent of an 8,000-meter peak.

Hermann Buhl’s feat is all the more remarkable because not only did he climb Nanga Parbat solo, and without oxygen, he reached the summit way back in 1953! Sadly, but perhaps inevitably, Buhl fell through a cornice on Chogolisa in the Karakoram ranges in Pakistan in 1957 – his body was never recovered.

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

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