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To the Editor.— We read with interest the report by Quan et al.1 The authors described normal or near-normal neurologic outcomes after cardiopulmonary arrest in 8 of 38 victims. We are encouraged by these results and agree that early, effective cardiopulmonary resuscitation is the most effective treatment for pediatric submersion victims. Several additional factors, however, must be considered when interpreting the results of this study. Quan et al describe the King County, Washington climate as "temperate" and note that "submersion victims in this region did not receive the potentially beneficial rapid cooling that icy waters may provide."