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Breindahl N, Wolthers SA, Jensen TW, Holgersen MG, Blomberg SNF, Steinmetz J, Christensen HC. Danish Drowning Formula for identification of out-of-hospital cardiac arrest from drowning. Am J Emerg Med 2023; 73:55-62. [PMID: 37619443 DOI: 10.1016/j.ajem.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Accurate, reliable, and sufficient data is required to reduce the burden of drowning by targeting preventive measures and improving treatment. Today's drowning statistics are informed by various methods sometimes based on data sources with questionable reliability. These methods are likely responsible for a systematic and significant underreporting of drowning. This study's aim was to assess the 30-day survival of patients with out-of-hospital cardiac arrest (OHCA) identified in the Danish Cardiac Arrest Registry (DCAR) after applying the Danish Drowning Formula. METHODS This nationwide, cohort, registry-based study with 30-day follow-up used the Danish Drowning Formula to identify drowning-related OHCA with a resuscitation attempt from the DCAR from January 1st, 2016, through December 31st, 2021. The Danish Drowning Formula is a text-search algorithm constructed for this study based on trigger-words identified from the prehospital medical records of validated drowning cases. The primary outcome was 30-day survival from OHCA. Data were analyzed using multiple logistic regression. RESULTS Drowning-related OHCA occurred in 374 (1%) patients registered in the DCAR compared to 29,882 patients with OHCA from other causes. Drowning-related OHCA more frequently occurred at a public location (87% vs 25%, p < 0.001) and were more frequently witnessed by bystanders (80% vs 55%, p < 0.001). Both 30-day and 1-year survival for patients with drowning-related OHCA were significantly higher compared to OHCA from other causes (33% vs 14% and 32% vs 13%, respectively, p < 0.001). The adjusted odds ratio for 30-day survival for drowning-related OHCA and other causes of OHCA was 2.3 [1.7-3.2], p < 0.001. Increased 30-day survival was observed for drowning-related OHCA occurring at swimming pools compared to public location OHCA from other causes with an OR of 11.6 [6.0-22.6], p < 0.001. CONCLUSIONS This study found higher 30-day survival among drowning-related OHCA compared to OHCA from other causes. This study proposed that a text-search algorithm (Danish Drowning Formula) could explore unstructured text fields to identify drowning persons. This method may present a low-resource solution to inform the drowning statistics in the future. REGISTRATION This study was registered at ClinicalTrials.gov before analyses (NCT05323097).
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Affiliation(s)
- Niklas Breindahl
- Prehospital Center Region Zealand, Ringstedgade 61, 13., 4700 Næstved, Denmark; Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Signe A Wolthers
- Prehospital Center Region Zealand, Ringstedgade 61, 13., 4700 Næstved, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Theo W Jensen
- Prehospital Center Region Zealand, Ringstedgade 61, 13., 4700 Næstved, Denmark; Copenhagen Emergency Medical Services, The Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup, Denmark
| | - Mathias G Holgersen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Emergency Medical Services, The Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup, Denmark; Department of Paediatrics and Adolescent Medicine, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Stig N F Blomberg
- Prehospital Center Region Zealand, Ringstedgade 61, 13., 4700 Næstved, Denmark
| | - Jacob Steinmetz
- Danish Air Ambulance, Brendstrupgårdsvej 7, 8200 Aarhus, Denmark; Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Helle C Christensen
- Prehospital Center Region Zealand, Ringstedgade 61, 13., 4700 Næstved, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Ryesgade 53B, 3., 2100 Copenhagen, Denmark
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2
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Zhou P, Xu H, Li B, Yang C, Zhou Z, Shi J, Li Z. Neurological outcomes in adult drowning patients in China. Ann Saudi Med 2022; 42:127-138. [PMID: 35380055 PMCID: PMC8982001 DOI: 10.5144/0256-4947.2022.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Drowning is the third leading cause of unintentional death worldwide. The epidemiological characteristics of adult drownings are rarely reported. OBJECTIVE Investigate factors associated with neurological prognosis in adult drowning inpatients. DESIGN Multicenter medical record review. SETTING Tertiary health care institutions. PATIENTS AND METHODS We collected demographic and clinical data on patients who drowned but survived between September 2006 and January 2020. Neurological prognosis was compared in patients with and without cardiac arrest. MAIN OUTCOME MEASURES Neurological outcomes. SAMPLE SIZE AND CHARACTERISTICS 142 patients with mean age of 50.6 (19.8) years, male/female ratio of 1.54:1. RESULT Forty-five patients (31.7%) received CPR, 90 patients (63.4%) experienced unconsciousness, and 59 patients (41.5%) received endotracheal intubation and mechanical ventilation. Multivariate logistic regression analysis showed that the initial blood lactic acid level (OR: 7.67, 95%CI: 1.23-47.82, P=.029) was associated with a poor neurological prognosis in patients without cardiac arrest. The incidence of ICU admission (OR: 16.604, 95%CI: 1.15-239.49, P=.039) was associated with a poor neurologic prognosis in patients with cardiac arrest. CONCLUSIONS For the drowning patients with cardiac arrest, ICU admission was associated with neurological function prognosis in these patients. Among the patients without cardiac arrest, the initial lactate value was associated with neurological function prognosis of these patients. LIMITATIONS Retrospective. CONFLICT OF INTEREST None.
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Affiliation(s)
- Peisen Zhou
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Huaqing Xu
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Bingccan Li
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Chenbing Yang
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Zhiliang Zhou
- From the Department of Emergency Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Jincun Shi
- From the Department of Emergency Medicine, Wenzhou Central Hospital, Zhejiang, China
| | - Zhangping Li
- From the The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Zhejiang, China
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Abstract
Internationally, drowning is a leading cause of accidental death that features in many legal cases. In these cases, possible mitigations and the ‘pain and suffering’ in terms of the duration and subjective experience of drowning are often pivotal in determining levels of compensation and outcome. As a result, there is a requirement to understand the stages of the drowning process, and the duration and physiological and subjective responses associated with each stage. In this short review we focus on these issues.
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Affiliation(s)
- Michael Tipton
- Extreme Environments Laboratory, School of Sport, Health & Exercise Sciences, University of Portsmouth, Portsmouth, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, University College London, London, UK
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4
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Reizine F, Delbove A, Dos Santos A, Bodenes L, Bouju P, Fillâtre P, Frérou A, Halley G, Lesieur O, Jonas M, Berteau F, Morin J, Luque-Paz D, Marnai R, Le Meur A, Aubron C, Reignier J, Tadié JM, Gacouin A. Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:372. [PMID: 34689813 PMCID: PMC8543920 DOI: 10.1186/s13054-021-03792-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/12/2021] [Indexed: 12/15/2022]
Abstract
Background Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients’ prognosis remains poorly explored in Intensive Care Units (ICUs) patients. Methods We conducted a retrospective multicenter study on patients admitted to 14 ICUs in the west of France from January 2013 to January 2020. We first compared demographic and clinical characteristics at admission as well as clinical courses of these patients according to the salinity of drowning water. Then, we aimed to identify variables associated with 28-day survival using a Cox proportional hazard model. Results Of the 270 consecutive included patients, drowning occurred in seawater in 199 patients (73.7%) and in freshwater in 71 patients (26.3%). Day-28 mortality was observed in 55 patients (20.4%). Freshwater was independently associated with 28-day mortality (Adjusted Hazard Ratio (aHR) 1.84 [95% Confidence Interval (CI) 1.03–3.29], p = 0.04). A higher proportion of freshwater patients presented psychiatric comorbidities (47.9 vs. 19.1%; p < 0.0001) and the etiology of drowning appeared more frequently to be a suicide attempt in this population (25.7 vs. 4.2%; p < 0.0001). The other factors independently associated with 28-day mortality were the occurrence of a drowning-related cardiac arrest (aHR 11.5 [95% CI 2.51–52.43], p = 0.0017), duration of cardiopulmonary resuscitation (aHR 1.05 [95% CI 1.03–1.07], p < 0.0001) and SOFA score at day 1 (aHR 1.2 [95% CI 1.11–1.3], p < 0.0001). Conclusions In this large multicenter cohort, freshwater drowning patients had a poorer prognosis than saltwater drowning patients. Reasons for such discrepancies include differences in underlying psychiatric comorbidity, drowning circumstances and severities. Patients with initial cardiac arrest secondary to drowning remain with a very poor prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03792-2.
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Affiliation(s)
- Florian Reizine
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France.
| | - Agathe Delbove
- CH Vannes, Service de Réanimation Polyvalente, 56000, Vannes, France
| | - Alexandre Dos Santos
- CH La Roche Sur Yon, Service de Réanimation Polyvalente, 85191, La Roche sur Yon, France
| | | | - Pierre Bouju
- CH Lorient, Service de Réanimation Polyvalente, 56100, Lorient, France
| | - Pierre Fillâtre
- CH Saint Brieuc, Service de Réanimation Polyvalente, 22000, Saint-Brieuc, France
| | - Aurélien Frérou
- CH Saint Malo, Service de Réanimation Polyvalente, 35400, Saint Malo, France
| | - Guillaume Halley
- CH Quimper, Service de Réanimation Polyvalente, 29000, Quimper, France
| | - Olivier Lesieur
- CH La Rochelle, Service de Réanimation Polyvalente, 17000, La Rochelle, France
| | - Maud Jonas
- CH Saint Nazaire, Service de Réanimation Polyvalente, 44600, Saint Nazaire, France
| | - Florian Berteau
- CH Morlaix, Service de Réanimation Polyvalente, 29600, Morlaix, France
| | - Jean Morin
- CHU Nantes, Médecine Intensive Réanimation, 44000, Nantes, France
| | - David Luque-Paz
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
| | - Rémy Marnai
- CH Le Mans, Service de Réanimation Polyvalente, 72000, Le Mans, France
| | - Anthony Le Meur
- CH Cholet, Service de Réanimation Polyvalente, 49300, Cholet, France
| | - Cécile Aubron
- CHU Brest, Médecine Intensive Réanimation, 29200, Brest, France
| | - Jean Reignier
- CHU Nantes, Médecine Intensive Réanimation, 44000, Nantes, France
| | - Jean-Marc Tadié
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
| | - Arnaud Gacouin
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
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Salas Ballestín A, de Carlos Vicente JC, Frontera Juan G, Sharluyan Petrosyan A, Reina Ferragut CM, González Calvar A, Clavero Rubio MDC, Fernández de la Ballina A. Prognostic Factors of Children Admitted to a Pediatric Intensive Care Unit After an Episode of Drowning. Pediatr Emerg Care 2021; 37:e192-e195. [PMID: 30020248 DOI: 10.1097/pec.0000000000001554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the prognostic factors of patients admitted to a pediatric intensive care unit (PICU) after drowning. METHODS Retrospective observational study from January 1992 to December 2004 and prospective study from January 2005 to December 2015 were conducted in a tertiary children's hospital PICU. The data analyzed refer to the patient, event, type of resuscitation performed, and clinical situation after resuscitation and at arrival to the PICU; results of additional tests; and clinical evolution and neurological status at discharge from the PICU (categorized as death, severe encephalopathy, or normal). The considered potential prognostic factors were whether drowning was witnessed, the type of initial resuscitation, Glasgow Coma Scale score at admission, pupil status and reactivity, and pH. RESULTS One hundred thirty-one patients were registered. Mortality was 16.7%, and 8.3% had significant neurological sequelae. The clearest factor associated with poor outcome was the type of initial resuscitation performed. All patients who did not require cardiopulmonary resuscitation (CPR), or only basic CPR, had good outcomes; 96.3% of those who required advanced CPR with epinephrine administration had poor outcomes. Patients who needed advanced resuscitation with administration of epinephrine had lower temperature, Glasgow Coma Scale score, pH, and bicarbonate at admission and higher level of glucose. In this group, there was also a higher incidence of seizures, acute respiratory distress syndrome, hemodynamic compromise, and acute renal failure. CONCLUSIONS The need for advanced CPR with epinephrine administration on the scene predicts poor neurological outcome (severe encephalopathy or death) in drowned children.
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Affiliation(s)
| | | | - Guillem Frontera Juan
- Clinical Research Unit, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, Spain
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Adult Basic Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A35-A79. [PMID: 33098921 PMCID: PMC7576327 DOI: 10.1016/j.resuscitation.2020.09.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 20 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 3 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review. Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest. The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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7
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Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castrén M, Chung SP, Considine J, Couper K, Escalante R, Hatanaka T, Hung KK, Kudenchuk P, Lim SH, Nishiyama C, Ristagno G, Semeraro F, Smith CM, Smyth MA, Vaillancourt C, Nolan JP, Hazinski MF, Morley PT, Svavarsdóttir H, Raffay V, Kuzovlev A, Grasner JT, Dee R, Smith M, Rajendran K. Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S41-S91. [DOI: 10.1161/cir.0000000000000892] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This2020 International Consensus on Cardiopulmonary Resuscitation(CPR)and Emergency Cardiovascular Care Science With Treatment Recommendationson basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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8
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Raess L, Darms A, Meyer-Heim A. Drowning in Children: Retrospective Analysis of Incident Characteristics, Predicting Parameters, and Long-Term Outcome. CHILDREN-BASEL 2020; 7:children7070070. [PMID: 32630249 PMCID: PMC7401877 DOI: 10.3390/children7070070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/19/2020] [Accepted: 06/26/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drowning is the second leading cause of unnatural death in childhood worldwide. More than half of the drowned children, who were in need of cardiopulmonary resuscitation (CPR) at the scene suffered from lifelong neurological sequelae. There are few data about prognostic predictors in the pediatric population of drowning victims. The objective of the study was to assess incident characteristics, prognostic parameters, and long-term outcome of children recovering from a drowning incident. METHODS We carried out a retrospective analysis of data of the cohort of pediatric cases (age 0-18) of drowning victims admitted in the years 2000-2015 to the emergency room/intensive care unit/pediatric ward at the University Children's Hospital of Zurich, Switzerland. Outcome was classified by the Pediatric Cerebral Performance Category Scale (PCPCS). New subcategories of severity for known prognostic parameters have been defined. A correlation analysis was performed between the subcategories of the prognostic parameters and the PCPCS. RESULTS A total of 80 patients were included in the analysis. Of these, 64% were male, most of the patients were at the age of 0-5 years. More than 80% of the patients were unattended at a public or private pool when the drowning incident happened. In all, 61% (n = 49) needed cardiopulmonary resuscitation (CPR). Of the resuscitated children, 63% showed good to mildly impaired long-term outcome (PCPCS 1-3). Furthermore, 15% (n = 12) were transferred to rehabilitation. Seven children died during the hospital stay and another four died due to complications in the ten years following the incident. The newly defined subcategories of the parameter submersion time, Glasgow Coma Scale (GCS) at time of admission, body temperature at time of admission, blood pH, blood glucose, and blood lactate level correlated significantly with the PCPCS. CONCLUSIONS Supervision of children, especially boys of the age 0-5 years, next to public or private pools is most important for prevention of drowning incidents in Switzerland. Cardiopulmonary resuscitation done by trained staff leads to a better long-term outcome. Medical decision making in severe cases of drowning should consider submersion time, GCS at time of admission, body temperature at time of admission, blood pH, blood glucose, and blood lactate levels, as these parameters correlate with long-term outcome.
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Ibuprofen-associated hypothermia in children: analysis of the Italian spontaneous reporting database. Eur J Clin Pharmacol 2016; 72:1239-1243. [DOI: 10.1007/s00228-016-2088-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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10
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Quan L, Bierens JJLM, Lis R, Rowhani-Rahbar A, Morley P, Perkins GD. Predicting outcome of drowning at the scene: A systematic review and meta-analyses. Resuscitation 2016; 104:63-75. [PMID: 27154004 DOI: 10.1016/j.resuscitation.2016.04.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/25/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify factors available to rescuers at the scene of a drowning that predict favourable outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase and Cochrane Library were searched (1979-2015) without restrictions on age, language or location and references lists of included articles. STUDY SELECTION Cohort and case-control studies reporting submersion duration, age, water temperature, salinity, emergency services response time and survival and/or neurological outcomes were eligible. Two reviewers independently screened articles for inclusion, extracted data, and assessed quality using GRADE. Variables for all factors, including time and temperature intervals, were categorized using those used in the articles. Random effects meta-analyses, study heterogeneity and publication bias were evaluated. RESULTS Twenty-four cohort studies met the inclusion criteria. The strongest predictor was submersion duration. Meta-analysis showed that favourable outcome was associated with shorter compared to longer submersion durations in all time cutoffs evaluated: ≤5-6min: risk ratio [RR]=2.90; (95% confidence interval [CI]: 1.73, 4.86); ≤10-11min: RR=5.11 (95% CI: 2.03, 12.82); ≤15-25min: RR=26.92 (95% CI: 5.06, 143.3). Favourable outcomes were seen with shorter EMS response times (RR=2.84 (95% CI: 1.08, 7.47)) and salt water versus fresh water 1.16 (95% CI: 1.08, 1.24). No difference in outcome was seen with victim's age, water temperatures, or witnessed versus unwitnessed drownings. CONCLUSIONS Increasing submersion duration was associated with worse outcomes. Submersion durations <5min were associated with favourable outcomes, while those >25min were invariably fatal. This information may be useful to rescuers and EMS systems deciding when to perform a rescue versus a body recovery.
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Affiliation(s)
- Linda Quan
- Department of Pediatrics, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA; Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98145, USA; Harborview Injury Prevention & Research Center, 401 Broadway, University of Washington, Seattle, WA 98122, USA.
| | - Joost J L M Bierens
- Research Group Emergency and Disaster Medicine, Vrije Universiteit Brussels, Pleinlaan 2, 1050 Elsene, Belgium
| | - Rebecca Lis
- Department of Epidemiology, School of Public Health, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Ali Rowhani-Rahbar
- Harborview Injury Prevention & Research Center, 401 Broadway, University of Washington, Seattle, WA 98122, USA; Department of Epidemiology, School of Public Health, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Peter Morley
- Royal Melbourne Hospital Clinical School, University of Melbourne, Grattan Street, Parkville, Victoria 3050, Australia
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
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Travers AH, Perkins GD, Berg RA, Castren M, Considine J, Escalante R, Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C. Part 3: Adult Basic Life Support and Automated External Defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2016; 132:S51-83. [PMID: 26472859 DOI: 10.1161/cir.0000000000000272] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review comprises the most extensive literature search and evidence evaluation to date on the most important international BLS interventions, diagnostics, and prognostic factors for cardiac arrest victims. It reemphasizes that the critical lifesaving steps of BLS are (1) prevention, (2) immediate recognition and activation of the emergency response system, (3) early high-quality CPR, and (4) rapid defibrillation for shockable rhythms. Highlights in prevention indicate the rational and judicious deployment of search-and-rescue operations in drowning victims and the importance of education on opioid-associated emergencies. Other 2015 highlights in recognition and activation include the critical role of dispatcher recognition and dispatch-assisted chest compressions, which has been demonstrated in multiple international jurisdictions with consistent improvements in cardiac arrest survival. Similar to the 2010 ILCOR BLS treatment recommendations, the importance of high quality was reemphasized across all measures of CPR quality: rate, depth, recoil, and minimal chest compression pauses, with a universal understanding that we all should be providing chest compressions to all victims of cardiac arrest. This review continued to focus on the interface of BLS sequencing and ensuring high-quality CPR with other important BLS interventions, such as ventilation and defibrillation. In addition, this consensus statement highlights the importance of EMS systems, which employ bundles of care focusing on providing high-quality chest compressions while extricating the patient from the scene to the next level of care. Highlights in defibrillation indicate the global importance of increasing the number of sites with public-access defibrillation programs. Whereas the 2010 ILCOR Consensus on Science provided important direction for the “what” in resuscitation (ie, what to do), the 2015 consensus has begun with the GRADE methodology to provide direction for the quality of resuscitation. We hope that resuscitation councils and other stakeholders will be able to translate this body of knowledge of international consensus statements to build their own effective resuscitation guidelines.
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 527] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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Perkins GD, Travers AH, Berg RA, Castren M, Considine J, Escalante R, Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C, Bierens JJ, Bourdon E, Brugger H, Buick JE, Charette ML, Chung SP, Couper K, Daya MR, Drennan IR, Gräsner JT, Idris AH, Lerner EB, Lockhat H, Løfgren B, McQueen C, Monsieurs KG, Mpotos N, Orkin AM, Quan L, Raffay V, Reynolds JC, Ristagno G, Scapigliati A, Vadeboncoeur TF, Wenzel V, Yeung J. Part 3: Adult basic life support and automated external defibrillation. Resuscitation 2015; 95:e43-69. [DOI: 10.1016/j.resuscitation.2015.07.041] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kieboom JK, Verkade HJ, Burgerhof JG, Bierens JJ, Rheenen PFV, Kneyber MC, Albers MJ. Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia: Dutch nationwide retrospective cohort study. BMJ 2015; 350:h418. [PMID: 25670715 PMCID: PMC4353310 DOI: 10.1136/bmj.h418] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation. DESIGN Nationwide retrospective cohort study. SETTING Emergency departments and paediatric intensive care units of the eight university medical centres in the Netherlands. PARTICIPANTS Children aged up to 16 with cardiac arrest and hypothermia after drowning, who presented at emergency departments and/or were admitted to intensive care. MAIN OUTCOME MEASURE Survival and neurological outcome one year after the drowning incident. Poor outcome was defined as death or survival in a vegetative state or with severe neurological disability (paediatric cerebral performance category (PCPC) ≥ 4). RESULTS From 1993 to 2012, 160 children presented with cardiac arrest and hypothermia after drowning. In 98 (61%) of these children resuscitation was performed for more than 30 minutes (98/160, median duration 60 minutes), of whom 87 (89%) died (95% confidence interval 83% to 95%; 87/98). Eleven of the 98 children survived (11%, 5% to 17%), but all had a PCPC score ≥ 4. In the 62 (39%) children who did not require prolonged resuscitation, 17 (27%, 16% to 38%) survived with a PCPC score ≤ 3 after one year: 10 (6%) had a good neurological outcome (score 1), five (3%) had mild neurological disability (score 2), and two (1%) had moderate neurological disability (score 3). From the original 160 children, only 44 were alive at one year with any outcome. CONCLUSIONS Drowned children in whom return of spontaneous circulation is not achieved within 30 minutes of advanced life support have an extremely poor outcome. Good neurological outcome is more likely when spontaneous circulation returns within 30 minutes of advanced life support, especially when the drowning incident occurs in winter. These findings question the therapeutic value of resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia.
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Affiliation(s)
- J K Kieboom
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Netherlands
| | - H J Verkade
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Netherlands
| | - J G Burgerhof
- Department of Epidemiology University Medical Centre Groningen, University of Groningen, Netherlands
| | - J J Bierens
- Van Heurnlaan 10-Anaesthesiology, Vught, Netherlands
| | - P F van Rheenen
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Netherlands
| | - M C Kneyber
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Netherlands
| | - M J Albers
- Department of Paediatrics, St Elizabeth's Hospital, Tilburg, Netherlands
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Bierens JJLM, Warner DS. Drowning resuscitation requires another state of mind. Resuscitation 2013; 84:1467-9. [PMID: 24036192 DOI: 10.1016/j.resuscitation.2013.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/04/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Joost J L M Bierens
- Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning), Rokin, Amsterdam 1012LB, The Netherlands.
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Topjian AA, Berg RA, Bierens JJLM, Branche CM, Clark RS, Friberg H, Hoedemaekers CWE, Holzer M, Katz LM, Knape JTA, Kochanek PM, Nadkarni V, van der Hoeven JG, Warner DS. Brain resuscitation in the drowning victim. Neurocrit Care 2013; 17:441-67. [PMID: 22956050 DOI: 10.1007/s12028-012-9747-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32-34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders.
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Affiliation(s)
- Alexis A Topjian
- The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Suite 7C23, Philadelphia, PA 19104, USA.
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Mark E, Jacobsen O, Kjerstad A, Naesheim T, Busund R, Bahar R, Jensen JK, Skorpen PK, Bjertnaes LJ. Hypothermic cardiac arrest far away from the center providing rewarming with extracorporeal circulation. Int J Emerg Med 2012; 5:7. [PMID: 22296952 PMCID: PMC3296662 DOI: 10.1186/1865-1380-5-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 02/01/2012] [Indexed: 12/29/2022] Open
Abstract
A 41-year-old man suffered hypothermic cardiac arrest after water immersion and was transported to our university hospital by ambulance helicopter for rewarming on cardiopulmonary bypass. He resumed spontaneous cardiac activity 6 h 52 min after cardiac arrest and recovered completely.
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Affiliation(s)
- Eckhard Mark
- Department of Emergency Medical Services, University Hospital of North Norway, Trom-sø, Norway.
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Borse NN, Hyder AA, Bishai D, Baker T, Arifeen SE. Potential Risk Estimation Drowning Index for Children (PREDIC): a pilot study from Matlab, Bangladesh. ACCIDENT; ANALYSIS AND PREVENTION 2011; 43:1901-1906. [PMID: 21819817 DOI: 10.1016/j.aap.2011.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 04/25/2011] [Accepted: 04/27/2011] [Indexed: 05/31/2023]
Abstract
UNLABELLED Childhood drowning is a major public health problem that has been neglected in many low- and middle-income countries. In Matlab, rural Bangladesh, more than 40% of child deaths aged 1-4 years are due to drowning. AIM The main objective of this paper was to develop and evaluate a childhood drowning risk prediction index. METHODOLOGY A literature review was carried out to document risk factors identified for childhood drowning in Bangladesh. The Newacheck model for special health care needs for children was adapted and applied to construct a childhood drowning risk index called "Potential Risk Estimation Drowning Index for Children" (PREDIC). Finally, the proposed PREDIC Index was applied to childhood drowning deaths and compared with the comparison group from children living in Matlab, Bangladesh. This pilot study used t-tests and Receiver Operating Characteristic (ROC) curve to analyze the results. RESULTS The PREDIC index was applied to 302 drowning deaths and 624 children 0-4 years old living in Matlab. The results of t-test indicate that the drowned children had a statistically (t=-8.58, p=0.0001) significant higher mean PREDIC score (6.01) than those in comparison group (5.26). Drowning cases had a PREDIC score of 6 or more for 68% of the children however, the comparison group had 43% of the children with score of 6 or more which was statistically significant (t=-7.36, p<0.001). The area under the curve for the Receiver Operating Characteristic curve was 0.662. CONCLUSION Index score construction was scientifically plausible; and the index is relatively complete, fairly accurate, and practical. The risk index can help identify and target high risk children with drowning prevention programs. PREDIC index needs to be further tested for its accuracy, feasibility and effectiveness in drowning risk reduction in Bangladesh and other countries.
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Affiliation(s)
- N N Borse
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA(1); Public Health Sciences Division, The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - A A Hyder
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA(1); International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - D Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - T Baker
- International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - S E Arifeen
- Public Health Sciences Division, The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Tipton MJ, Golden FSC. A proposed decision-making guide for the search, rescue and resuscitation of submersion (head under) victims based on expert opinion. Resuscitation 2011; 82:819-24. [PMID: 21458133 DOI: 10.1016/j.resuscitation.2011.02.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 02/08/2011] [Accepted: 02/11/2011] [Indexed: 11/17/2022]
Abstract
There is some confusion, and consequent variation in policy, between the agencies responsible for the search, rescue and resuscitation of submersion victims regarding the likelihood of survival following a period of submersion. The aim of this work was to recommend a decision-making guide for such victims. This guidance was arrived at by a review of the relevant literature and specific case studies, and a "consensus" meeting on the topic. The factors found to be important for determining the possibility of prolonged survival underwater were: water temperature; salinity of water; duration of submersion; and age of the victim. Of these, only water temperature and duration are sufficiently clear to form the basis of guidance in this area. It is concluded that if water temperature is warmer than 6°C, survival/resuscitation is extremely unlikely if submerged longer than 30 min. If water temperature is 6°C or below, survival/resuscitation is extremely unlikely if submerged longer than 90 min.
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Affiliation(s)
- Michael J Tipton
- Spinnaker Building, Cambridge Road, University of Portsmouth, Portsmouth PO1 2ER, UK.
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22
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Holmaas G, Vikenes BH. Survival after 48 min submersion and 107 min cardiopulmonary resuscitation. Resuscitation 2011; 82:494-5. [PMID: 21296478 DOI: 10.1016/j.resuscitation.2010.09.482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
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Lienhart HG, John W, Wenzel V. Cardiopulmonary resuscitation of a near-drowned child with a combination of epinephrine and vasopressin. Pediatr Crit Care Med 2005; 6:486-8. [PMID: 15982441 DOI: 10.1097/01.pcc.0000163673.40424.e7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report a cardiopulmonary resuscitation attempt in a 20-month-old child employing a combination of vasopressin and epinephrine. DESIGN Case report. SETTING Out-of-hospital cardiopulmonary resuscitation. PATIENT A 20-month-old child found in cardiac arrest after submersion. INTERVENTIONS AND RESULTS Dispatcher-assisted basic life support was initiated immediately after pulling the child out of the water. The emergency medical service crew arrived approximately 6 mins later and found a hypothermic, cyanotic child in cardiocirculatory arrest. The first electrocardiogram showed sinus bradycardia. After intubation and administration of epinephrine and atropine with no effect, an intravenous bolus of 0.2 mg of epinephrine and 10 IU of vasopressin resulted in restoration of spontaneous circulation. The boy was flown to a hospital and was discharged 23 days later to a rehabilitation facility. He returned home 6 months after the accident, where further rehabilitation efforts are pending. CONCLUSION Bystander cardiopulmonary resuscitation, early and aggressive advanced life support, rewarming, and the combination of intravenous epinephrine and vasopressin were associated with sustained return of spontaneous circulation following hypothermic submersion-associated cardiac arrest.
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Affiliation(s)
- Hannes G Lienhart
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
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Zuckerbraun NS, Saladino RA. Pediatric Drowning: Current Management Strategies for Immediate Care. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2005. [DOI: 10.1016/j.cpem.2004.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Dueker CW. Immersion in Fresh Water and Survival. Chest 2004; 126:2027-8; author reply 2028-9. [PMID: 15596713 DOI: 10.1378/chest.126.6.2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Szpilman D, Soares M. In-water resuscitation—is it worthwhile? Resuscitation 2004; 63:25-31. [PMID: 15451583 DOI: 10.1016/j.resuscitation.2004.03.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Revised: 03/14/2004] [Accepted: 03/14/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES At present, there is no reliable information indicating the best option of rescuing a non-breathing drowning victim in the water. Our objectives were to compare the outcomes of performing immediate in-water resuscitation (IWR) or delaying resuscitation until the victim is brought to shore. MATERIAL AND METHODS A retrospective data analysis was conducted of non-breathing drowning victims rescued by lifeguards in the coastal area of Rio de Janeiro, Brazil. Patients were coded as IWR and no-IWR (NIWR) cases based on the lifeguard's decision whether to perform IWR. Death and development of severe neurological damage (SND) were considered poor outcome. RESULTS Forty-six patients were studied. Their median age was 17 (9-31) years. Nineteen (41.3%) patients received IWR and 27 (58.7%) did not. The mortality rate was lower for IWR cases (15.8% versus 85.2%, P < 0.001). However, among surviving IWR cases, 6 (31.6%) developed SND. In multivariate analysis, higher age [odds ratio (OR) = 1.12 (95% confidence interval (CI) = 1.01-1.24), P = 0.038] was associated with death, while IWR [ OR = 0.05 (95% CI = 0.01-0.50), P = 0.011] was protective. When death or the development of SND was set as the dependent variable, longer cardiopulmonary arrest (CPA) duration was the unique variable selected (OR = 1.77 (95% CI = 1.13-2.79), P = 0.013]. Every patient with CPA duration higher than 14 min had a poor outcome. CONCLUSIONS Delaying resuscitation efforts were associated with a worse outcome for non-breathing drowning victims. In the cases studied, IWR was associated with improvement of the likelihood of survival. An algorithm was developed for its indications and to avoid unnecessary risks to both victim and rescuer.
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Affiliation(s)
- David Szpilman
- Fire Department of Rio de Janeiro-Drowning Resuscitation Center of Barra da Tijuca (CBMERJ-GMAR-GSE), Av. das Américas 3555, Bloco 2, sala 302, Rio de Janeiro RJ 22793-004, Brazil.
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Affiliation(s)
- C J McNamee
- Department Surgery, University of Massachusetts Medical School, 67 Belmont Street, Worcester, MA 01605, USA.
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Abstract
Several myths about drowning have developed over the years. This article has attempted to dispel some of these myths, as follows: 1. Drowning victims are unable to call or wave for help. 2. "Dry drownings" probably do not exist; if there is no water in the lungs at autopsy, the victim probably was not alive when he or she entered the water. 3. Do not use furosemide to treat the pulmonary edema of drowning; victims may need volume. 4. Seawater drowning does not cause hypovolemia, and freshwater drowning does not cause hypervolemia, hemolysis, or hyperkalemia. 5. Drowning victims swallow much more water than they inhale, resulting in a high risk for vomiting spontaneously or on resuscitation. No discussion of drowning would be complete without mentioning the importance of prevention. Proper pool fencing and water safety training at a young age are instrumental in reducing the risk for drowning. Not leaving an infant or young child unattended in or near water can prevent many of these deaths, especially bathtub drownings. Also crucial is the use of personal flotation devices whenever boating. Proper training in water safety is crucial for participation in water recreation and sporting activities, including SCUBA diving. The incidence of pediatric drowning deaths in the United States has decreased steadily over the past decade, perhaps as a result of increased awareness and attention to drowning-prevention measures (Box 1).
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Affiliation(s)
- J P Orlowski
- Division of Pediatrics, Department of Pediatric Critical Care Medicine, University Community Hospital, Tampa, Florida, USA
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Chochinov AH, Baydock BM, Bristow GK, Giesbrecht GG. Recovery of a 62-year-old man from prolonged cold water submersion. Ann Emerg Med 1998; 31:127-31. [PMID: 9437357 DOI: 10.1016/s0196-0644(98)70296-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recovery from prolonged cold water submersion is well documented in children but rare in adults. In the few adult cases reported, significant body cooling occurred (rectal temperature ranging from 22 degrees to 32 degrees C) and the victims were relatively young (< 40 years). We report a case of a 62-year-old man who was submersed in 2 degrees to 3 degrees C water for 15 minutes (time from initial submersion to intubation = 22 minutes). At the time of rescue, he had no vital signs, received prehospital Advanced Life Support, and was transported to hospital. On arrival at hospital, the patient remained in full cardiopulmonary arrest with an agonal ECG rhythm and had an initial pH of 6.77. Initial rectal temperature was near normal (36 degrees C) but subsequently dropped to 33 degrees C. The patient was resuscitated, rewarmed by forced-air warming, and treated for acute myocardial infarction, pulmonary edema, and generalized seizures. He was discharged after 27 days with minor neurologic abnormalities. Given the near-normal initial rectal temperature, preferential brain cooling may have been at least partially responsible for the positive neurologic outcome.
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Affiliation(s)
- A H Chochinov
- Department of Family Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
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Szpilman D. Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1,831 cases. Chest 1997; 112:660-5. [PMID: 9315798 DOI: 10.1378/chest.112.3.660] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVE To establish an updated classification for near-drowning and drowning (ND/D) according to severity, based on mortality rate of the subgroups. MATERIALS AND METHODS We reviewed 41,279 cases of predominantly sea water rescues from the coastal area of Rio de Janeiro City, Brazil, from 1972 to 1991. Of this total, 2,304 cases (5.5%) were referred to the Near-Drowning Recuperation Center, and this group was used as the study database. At the accident site, the following clinical parameters were recorded: presence of breathing, arterial pulse, pulmonary auscultation, and arterial BP. Cases lacking records of clinical parameters were not studied. The ND/D were classified in six subgroups: grade 1--normal pulmonary auscultation with coughing; grade 2--abnormal pulmonary auscultation with rales in some pulmonary fields; grade 3--pulmonary auscultation of acute pulmonary edema without arterial hypotension; grade 4--pulmonary auscultation of acute pulmonary edema with arterial hypotension; grade 5--isolated respiratory arrest; and grade 6--cardiopulmonary arrest. RESULTS From 2,304 cases in the database, 1,831 cases presented all clinical parameters recorded and were selected for classification. From these 1,831 cases, 1,189 (65%) were classified as grade 1 (mortality=0%); 338 (18.4%) as grade 2 (mortality=0.6%); 58 (3.2%) as grade 3 (mortality=5.2%); 36 (2%) as grade 4 (mortality=19.4%); 25 (1.4%) as grade 5 (mortality=44%); and 185 (10%) as grade 6 (mortality=93%) (p<0.000001). CONCLUSION The study revealed that it is possible to establish six subgroups based on mortality rate by applying clinical criteria obtained from first-aid observations. These subgroups constitute the basis of a new classification.
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Affiliation(s)
- D Szpilman
- Fire Department of Rio de Janeiro, Near-Drowning Recuperation Center of Barra da Tijuca, Miguel Couto Municipal Hospital, Brazil.
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Abstract
STUDY OBJECTIVE To predict outcome in children after near-drowning. DESIGN Retrospective cohort study. Vegetative state and death were classified as unfavorable outcomes, whereas all other outcomes were classified as favorable. Demographic, episode-related, clinical, laboratory, and treatment variables available at the time of admission were evaluated for their usefulness in predicting outcome. SETTING Pediatric referral hospital. PARTICIPANTS Children admitted after submersion injury in non-icy waters. RESULTS The study cohort comprised 194 children (median age, 2.6 years; range, 5 months to 18 years); 131 were neurologically normal at the time of discharge, 10 had some degree of neurologic impairment, 15 were in a vegetative state at the time of discharge, and 38 died. We used a combination of partitioning and logistic regression to combine variables in a prediction rule that was always correct when unfavorable outcome was predicted. The final rule predicted favorable outcome for all children who were not comatose. Among comatose children, unfavorable outcome was predicted by a combination of absent pupillary light reflex, increased initial blood glucose concentration, and male sex. This rule had a specificity of 100%--children with favorable outcomes were always predicted to do well--and a sensitivity of 65%. Therefore the rule was overly optimistic for 35% of patients with unfavorable outcomes. CONCLUSION Pediatric submersion victims can be assigned to high or low likelihoods of unfavorable outcome with the use of four variables: comatose state, lack of pupillary light reflex, sex, and initial blood glucose concentration. This prediction rule may be useful if it can be validated in another cohort.
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Affiliation(s)
- W D Graf
- Department of Pediatrics, Children's Hospital and Medical Center, University of Washington School of Medicine, USA
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Abstract
Irrespective of the immersion medium, the primary consequence of any near drowning episode is hypoxemia and resultant hypoxia. The gravest consequence of hypoxia is cerebral insult. A major contributor to cerebral recovery in cold water drowning is hypothermia and resultant cerebral hypometabolism. Though the causal mechanism of this phenomenon is the focus of debate, hypothermia at presentation remains a good prognostic indicator. Nursing and medical care should be directed towards reversal of hypoxemia and cerebral salvage with this factor in mind, rather than expectation of relatively rare sequelae. This article reviews the pathophysiology of near drowning and contemporary trends in its treatment.
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Affiliation(s)
- H M Corneli
- Department of Pediatrics, University of Utah College of Medicine, Salt Lake City
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