An official autopsy report released this week found that Texas snowmobiler Caleb Moore died from a "blunt force chest injury and complications thereof" after a crash in the Snowmobile Freestyle finals at X Games Aspen in Colorado in January.
Moore, a four-time Winter X Games medalist, crashed after under-rotating a backflip during his competition run. The injuries caused by the blunt force included a cardiac contusion, rib fractures, a contusion of the anterior chest wall, and mild acute brain injury, according to forensic pathologist Robert A. Kurtzman of Rocky Mountain Forensic Services.
"He was briefly unconscious immediately after the fall, but was able to ambulate and speak with his team members while leaving the track," the forensic report said. "He collapsed shortly thereafter and was transported to Aspen Valley Hospital where he was diagnosed with a chest injury, including a presumptive hemopericardium (blood accumulation around the heart)."
Pitkin County coroner Dr. Steve Ayers told ESPN that he now believes Moore might have survived if he had access to a heart surgeon sooner. Kurtzman's report found that anoxic encephalopathy -- lack of oxygen to the brain -- developed "as a consequence of cardiopulmonary arrest that occurred during transport to St. Mary's Hospital in Grand Junction from Aspen Valley Hospital in Aspen."
"It's such a tragic thing because we're in a rural location and we just don't have heart surgeons here," Ayers said. "He probably would have had heart surgery much sooner had he been in an urban area, but it's a long way from Aspen to Denver or Grand Junction. It's just the reality of being in a relatively rural setting, unfortunately."
The 25-year-old Moore was given advanced cardiovascular support during his transport to a hospital in Grand Junction for surgery, according to the forensic report. He had fluid aspirated from the sac enveloping his heart through a procedure called pericardiocentesis, as well as "needle compression of the right and left hemithorax before a heart beat and blood pressure returned." But "several hours elapsed prior to and during transport," according to the report, an interval of approximately six hours from the time of injury to arrival at St. Mary's.
Moore remained unconscious with "no improvement over the ensuing days" and was pronounced dead on Jan. 31 at 9:30 a.m.
The final autopsy report took longer than usual, Ayers says, because his department consulted with an outside specialist for a full neuropathology review.
"We wanted to make sure to get all the answers possible and we wanted, specifically, to have the brain looked at by a neuropathologist to help distinguish what lead to the brain death," Ayers said. "Was it the trauma from the snowmobile accident combined with previous head injuries? Or was it the lack of oxygen from the cardiac arrest? Or some combination?
"We concluded that it was mostly the lack of oxygen during the cardiac arrest."