Near drowning: is emergency department cardiopulmonary resuscitation or intensive care unit cerebral resuscitation indicated?

Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine 19104-4399.
Critical Care Medicine (Impact Factor: 6.15). 03/1993; 21(3):368-73. DOI: 10.1097/00003246-199303000-00013
Source: PubMed

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.

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    07/2012; DOI:10.5835/jecm.omu.29.02.008
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    ABSTRACT: Background The aim of this study was to determine the early outcomes of using extracorporeal membrane oxygenation (ECMO) in near-drowning patients with cardiac or pulmonary failure.Methods This study was based on data from 9 patients including 2 children (mean age 33; 8 males, 1 female) who received ECMO after near-drowning between 2008 and 2013. Veno-arterial or veno-arteriovenous ECMO was used in 2 patients with sustained cardiac arrest and veno-venous ECMO was used in 7 patients with severe acute respiratory distress syndrome (ARDS). The means of the partial arterial oxygen pressure (PaO2), Murray score, sequential organ failure assessment (SOFA) score, and simplified acute physiology score II (SAPS-II) prior to ECMO were 59.7¿±¿9.9 mmHg on 100% oxygen, 3.5¿±¿0.6, 11.4¿±¿1.9, and 73.0¿±¿9.2, respectively.ResultsThe PaO2 mean improved to 182¿±¿152 mmHg within 2 h post-ECMO. The mean of SOFA score and SAPS-II decreased significantly to 8.6¿±¿3.2 (p¿=¿0.013) and 46.4¿±¿5.1 (p¿=¿0.008), respectively, at 24 h post-ECMO with mean flow rate of 3.9¿±¿0.8 l/min. ECMO was weaned at a mean duration of 188 (range, 43¿672) h in all patients. Seven patients were discharged home without neurological sequelae, while 2 patients who had hypoxic brain damage died after further referral. The overall survival with favourable neurological outcomes at 3 months was 77.8%. There were no complications related to ECMO.ConclusionsECMO was safe and effective for patients with ongoing cardiac arrest or ARDS after a near-drowning incident and can be used as a resuscitative strategy in near-drowning patients with cardiac or pulmonary failure resistant to conventional ventilator therapy.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 12/2014; 22(1):77. DOI:10.1186/s13049-014-0077-8 · 1.93 Impact Factor
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    Chapter: Drowning
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    ABSTRACT: submersion and immersion. This chapter focuses on submersion and reviews the epidemiol-ogy, pathophysiology, and treatment of this mainly respira-tory problem. Hypothermia-related immersion issues are described in Chapter 49. 1 Epidemiology Circumstances of drowning vary around the world; from healthy toddlers to desperate boat refugees, and from beach to bathtub. According to the WHO report, each year between 350 000 and 450 000 persons die from drowning. In addition, in some years, over 500 000 persons have drowned in floods and tsunamis. Most drowned victims are children, and the potential years of life lost are immense. Within this global perspective, 97% of all drowning occurs in South East Asia, the Pacific, and Africa. In some areas, the drowning rate is as high as 400 persons per 100 000 inhabitants. The leading cause of drowning in these areas is multifactorial. Leisure, work, transport, and collecting water for household purposes occur in the surroundings of water. Swimming skills are lacking, as is the knowledge on how to perform rescue, first aid, or basic life support (BLS). Also, prevention efforts, rescue resources, or communication equipment are poor. 2–4 In the Western world, a combination of socioeconomic factors, legislation, multifaceted prevention programs, improved rescue techniques, and up-to-date medical systems have resulted in a 10-to 20-fold decrease in drowning rates during the last 50 years. The death rate is between 0.1 and 2.5 per 100 000 inhabitants. High risk groups are children (because of their exploratory behav-ior), ethnic minorities (because they have poorer swim-ming skills and are unfamiliar with water hazards), car occupants (because of blocked escape routes from cars with maximum active safety protection), and water recre-ationers (because of inadequate preparation and alcohol use). Certain countries or areas have specific, and some-times unique, riskgroups: Alaska and Iceland (commercial fisherman). 5,6 Japan (hot tub drowning), 7 and Australia and the southern areas of the USA (private swimming pool drowning). 8,9 Recent data from the Netherlands suggest another new trend: scoot-mobiles and walker-related drowning in the elder generation. 10 An important cause of drowning in the Western world is suicide, and in some countries the incidence of suicidal drowning is three times larger than that of accidental drowning. 11 Homicide has been suggested to be underreported in paediatric bathtub drowning. 12 For most types of drowning, males have an approximately 4-fold greater incidence of drowning than do females, except for suicide. 12,13
    Cardiac Arrest: The Science and Practice of Resuscitation Medicine, 2nd edited by ed. Norman Paradis, Henry Halperin, Karl Kern, Volker Wenzel, Douglas Chamberlain, 01/2007: chapter 61: pages 1086-100; Cambridge University Press.