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.
- Pediatric emergency care 10/2005; 21(9):610-6; quiz 617-9. · 0.92 Impact Factor
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ABSTRACT: This review will introduce new universal terminology recommended for drowning, review the pathophysiology of drowning, and discuss current management strategies for treating the drowning victim. Drowning is a major burden of injury for children. The drowning process results in hypoxia, the degree of which ultimately determines clinical outcome. No single or combination of variables has proven to be reliably predictive of poor outcome. Initial care is focused on reversing the hypoxia and maintaining cardiovascular stability. Injuries associated with drowning can be complicated by hypothermia as well as predisposing medical and traumatic conditions, all of which will need to be addressed concomitantly. Posthypoxic cerebral encephalopathy is a delayed outcome of drowning associated with the greatest morbidity. Thus, early measures to prevent secondary brain injury are important.Clinical Pediatric Emergency Medicine 01/2005; 6(1):49-56.
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ABSTRACT: Aim: To review the outcome of childhood submersion injury (SI). We reviewed discharge data of all children with SI who were hospitalized in a university teaching hospital between January 2002 and January 2008. There were 15 admissions (8 males and 7 females). Outdoor SI (n = 10) were more common than indoor SI (n = 5) and 7 cases occurred in public swimming pools with life guard service. There were significant differences between the two types of SI. Indoor SI more likely occurred in the Chinese mainland. The victims were generally younger, more likely to have low Glasgow Coma Scale (GCS), asystole and intubation at the emergency department (ED). They were more likely to require intensive care, ventilatory support, neurological imaging and had worse neurological sequlae of death or hypoxic-ischaemic encephalopathy (HIE). Indoor SI was associated with worse prognosis. All patients with GCS of 3 at ED and required intensive care support were either dead or incapacitated. Low GCS, pulselessness and intubation at the ED and seizures are also associated with adverse outcomes. Describing the mode of paediatric SI in a city where SI rarely occurs serves to heighten public awareness especially of home safety in the prevention of SI.Acta Paediatrica 06/2008; 97(9):1261-4. · 1.97 Impact Factor