Near drowning: Is emergency department cardiopulmonary resuscitation or intensive care unit cerebral resuscitation indicated?
ABSTRACT a) To report the neurologic outcome of a series of near-drowning victims treated with supportive management without aggressive cerebral resuscitation; and b) to identify patient characteristics that indicate prognosis and guide therapy at the scene, the Emergency Department, and in the intensive care unit (ICU).
Retrospective review of all near-drowning patients requiring admission to the ICU over a 6-yr period (1/1/82 to 12/31/88). Hospital records were examined for the circumstances of submersion and rescue, patient condition on arrival in the Emergency Department and ICU, treatments, hospital course, and ultimate outcome.
Emergency departments of the referring hospital and ICU of Children's Hospital.
Forty-four pediatric submersion victims were treated with therapy limited to the support of vital functions. Three patients who met cold-water drowning criteria were excluded from the analysis for predictors of neurologic outcome.
In our warm-water near-drowning patients, 56% survived neurologically intact, 32% survived in a persistent vegetative state, and the remaining 32% died. Unreactive pupils in the Emergency Department and a Glasgow Coma Score of < or = 5 on arrival to the ICU were the best independent predictors of poor neurologic outcome (odds ratio and 95% confidence intervals 374 [17 to 16,000] and 51 [5 to 2,200], respectively). However, no predictor was absolute and two nonhypothermic patients who arrived to the Emergency Department without vital signs, requiring cardiopulmonary resuscitation and cardiotonic medications, had full neurologic recovery.
Our results cast further doubt on the utility of aggressive forms of cerebral monitoring and resuscitation and emphasize the need for initial full resuscitation in the Emergency Department.
- SourceAvailable from: Nurşah Başol
- "Hastaların acil servise geliş anında bakılan GKS'si ve pupillerin ışığa cevabı hastaların nörolojik durumlarını değerlendirmede en önemli belirteçlerdir. Lavelle ve Shaw (1993) geriye dönük olarak 44 boğulma olgusunu incelemişler ve kötü nörolojik prognozun en iyi göstergesi olarak GKS'nin 5'in altında olması ile birlikte pupillerin ışığa cevapsızlığı olduğunu ifade etmişlerdir. Başka bir çalışmada başarılı bir kardiyopulmoner resüsitasyon sonrası yoğun bakım ünitesinde takip edilen 43 olguda GKS'nin 5 ve altında olması ile pupillerin ışığa cevapsızlığının direkt mortalite ile ilişkili olduğu bulunmuştur (Ballesteros ve ark., 2009). "
[Show abstract] [Hide abstract]
- "Was the time to achieve hypothermia the same in both children? Excluding bystander CPR, the remaining factors are considered strong predictors of outcome after near drowning [1,3,8]. The girl developed ARDS and septic shock, whereas the boy recovered from aspiration pneumonia without further complications. "
ABSTRACT: We report a case of twin toddlers who both suffered near drowning but with different post-trauma treatment and course, and different neurological outcomes. Two twin toddlers (a boy and girl, aged 2 years and 3 months) suffered hypothermic near drowning with protracted cardiac arrest and aspiration. The girl was treated with mild hypothermia for 72 hours and developed acute respiratory dysfunction syndrome and sepsis. She recovered without neurological deficit. The boy's treatment was conducted under normothermia without further complications. He developed an apallic syndrome. Although the twin toddlers experienced the same near drowning accident together, the outcomes with respect to neurological status and postinjury complications were completely different. One of the factors that possibly influenced the different postinjury course might have been prolonged mild hypothermia.Critical care (London, England) 11/2004; 8(5):R353-7. DOI:10.1186/cc2926
- [Show abstract] [Hide abstract]
ABSTRACT: The purpose of the study was to evaluate the outcome of warm pediatric near drowning, and assess possible predictors of the outcome. The study was performed at King Khalid University Hospital, Riyadh, Saudi Arabia. Twenty-eight cases of pediatric near drowning (one to 13 years of age) over a 10-year period ending June 1998, were reviewed retrospectively. Multiple variables during the prehospital and the hospital stages were evaluated to assess their effect on the outcome. None of the patients' families had official training in cardiopulmonary resuscitation. Only one of the 21 private swimming pools had features compatible with swimming pool safety regulations. Eleven patients (39.3%) died in the pediatric intensive care, and 17 (60.7%) were discharged alive. Submersion time of >5 minutes and the emergency room documentation of absence of vital signs, Glasgow Coma Scale of < or =4, arterial pH of < or =7.0 and blood sugar of > or =10 mmol/L all predicted bad outcome, with a statistical significance (P< 0.05). This audit highlighted major concerns about our prehospital medical care, general population basic life support education and our society's adherence to swimming pool safety regulations. It demonstrated that hypothermia on arrival to the emergency department in warm near-drowning victims is likely to be associated with bad outcome. The audit results also agree with the opinion of not aggressively intervening or prolonging aggressive intervention in warm near-drowning cases presenting with bad prognostic outcome.Annals of Saudi medicine 21(5-6):300-3. · 0.71 Impact Factor