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Objectives: Drowning is the second leading cause of death in children.Extracorporeal membrane oxygenation (ECMO) has become the criterion standard therapy to resuscitate the hypothermic drowning victim in cardiac arrest. We present our own experience treating 5 children with hypothermic cardiac arrest in conjunction with a systematic review to analyze clinical features predictive of survival.Methods: Our search resulted in 55 articles. Inclusion criteria were as follows: (1) younger than 18 years, (2) ECMO therapy, and (3) drowning. Ten articles met our inclusion criteria. We included studies using both central and peripheral ECMO and salt or fresh water submersions. We compared clinical features of survivors to nonsurvivors.Results: A total of 29 patients from the 10 different studies met our criteria.Data analyzed included presenting cardiac rhythm, time to initiation of ECMO, submersion time, pH, potassium, lactate, duration of chest compressions, and survival. There was a significant increase in mortality for presenting rhythm of asystole and with hyperkalemia (P < 0.05).Conclusions: Extracorporeal membrane oxygenation is an important resuscitation tool for the hypothermic drowning victim. Hyperkalemia and presenting cardiac rhythm correlate with survival although they are not reasons to end resuscitation. More studies are needed to compare the outcomes in using ECMO for the hypothermic drowning victim.

Purpose While it is well‐known that injuries are a common cause of morbidity among children, limited information is available on injuries that occur in agricultural settings. This study characterizes pediatric farm injuries that present to United States emergency departments and compares them to injuries that occur in the normal course of childhood, at homes and residences. Methods A retrospective analysis of the National Electronic Injury Surveillance System‐All Injury Program, 2001‐2014, compared injuries occurring on farms to those at homes in youth ages <20 years. Linear regression models assessed injuries over the time period among demographic subgroups. Findings Between 2001 and 2014, there were an estimated 279,279 injuries that occurred on farms in youth <20 years. Farm injuries most commonly occurred among youth ages from 15 to 19 years (44%, 95% confidence interval [CI]: 39%‐49%), whereas home injuries were often among children <5 years (42%, 95% CI: 39%‐45%). After adjusting for confounders, farm injuries were 60 times more likely to be caused by machinery and 4 times more likely to result in hospitalization than home injuries. Overall, the number of farm injuries decreased by 44% between 2001 and 2014. Conclusions Characteristics of youth farm injuries are much different from injuries occurring at homes. Although the overall number of farm injuries among youth has decreased substantially over time, injury prevention initiatives targeted toward these particular injuries are important to continue due to the significant morbidity of these injuries.