Childhood near-drowning

Rewarming from accidental hypothermia by extracorporeal circulation. A retrospective study

“…Peterson [15] found no neurological intact survivors in subjects requiring CPR after admission to the emergency department. Most studies report a signi®cant incidence of severely neurologically impaired survivors among patients requiring prolonged CPR [14]. All our patients present within the asphyxia group were admitted to our ED after prolonged CPR and still in cardiorespiratory arrest.…”

“…A major part of the patients in our asphyxia group are paediatric near-drowning/drowning cases. Although a few reports during the last decades have revealed a small, but signi®cant number of paediatric near-drowning victims who recovered without major neurological sequelae after arriving in the ED in a comatose state [11±13], most authors describe a dismal prognosis of near-drowning/ drowning patients admitted with circulatory arrest [13,14]. The low median age in the non-survivor group compared to median age of survivors (Table 5) is explained by the fact that a major part of our patients were neardrowning/drowning cases, and not by the age per se as negative predictor.…”

Neurologic long term outcome after drowning in children

“…Important predictors for survival itself either with mild or severe neurological deficits include: the duration of submersion, the need of advanced life support at the site of the accident, the duration of CPR, and the establishment of spontaneous breathing and circulation on arrival to the ER [3,5,8,10,16,27,32]. Submersion time mainly determines the level of hypoxic-ischemic injury but it is at best an estimate given in an extremely stressful situation.…”

“…Many other predictors of survival that have been reported in the literature are mainly consequences of the duration of the primary insult of CPR and the quality of the treatment the patient has received before or after the arrival to the ER. Laboratory values such as severe acidotic pH-values, high blood sugar and lactate are usually signs of a long submersion and resuscitation time and therefore they are signs of poor outcome except in hypothermic children drowned in icy water [7,10,27,32-36]. There are insufficient data on biochemical markers such as neuron-specific enolase (NSE) or serum astroglial protein (S-100B) in children after cardiac arrest to help outcome prediction [31].…”