Abstract : In avalanche victims, the most common cause of death is asphyxia, followed less frequently by trauma and hypothermia. In patients extricated in cardiac arrest, decisions regarding the intensity of treatment-particularly the use of extracorporeal life support and rewarming (ECLS/ECMO)-must be made rapidly and often on the basis of incomplete information. In this context, serum potassium concentration (K⁺) has for many years functioned as a “hard” marker of irreversible cellular death and prolonged asphyxia. Over recent years, however, the emphasis has shifted. Potassium remains an important parameter, but it is now interpreted within a broader clinical context and incorporated into multiparametric prognostic tools such as the Hypothermia Outcome Prediction after ECLS (HOPE) score, as well as the European Resuscitation Council (ERC) 2025 guidelines and recommendations from mountain medicine organizations, including ICAR MedCom and the Wilderness Medical Society. This narrative review discusses the pathophysiology of potassium disturbances in avalanche burial, current algorithms for clinical decision-making, and recent evidence regarding the prognostic value of serum potassium. Particular attention is paid to interpretative pitfalls which, in practice, may lead either to premature termination of resuscitation or, conversely, to the initiation of futile treatment.