Prognostic factors and outcome after drowning in an adult population

Ballesteros, M.Á.; Gutiérrez‐Cuadra, Manuel; Muñoz, Pedro; Miñambres, Eduardo

doi:10.1111/j.1399-6576.2009.02020.x

Cited by 23 publications

(27 citation statements)

References 31 publications

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“…It is unclear when the absence of pupillary responsiveness to light predicts poor outcome. Small retrospective drowning studies have shown absence of pupillary response in the emergency department or ICU to be associated with poor neurologic outcome [119-123]. While pupillary response may return within hours of resuscitation [118], an absent pupillary response at 24 h is associated with poor neurologic outcome [70, 124, 125].…”

Section: Neuromonitoringmentioning

confidence: 99%

“…A composite GCS score ≤ 5 on ICU admission after drowning is associated with poor outcome, however, it is only 75 % specific to detect patients with a poor outcome. Some patients with a GCS ≤ 5 on ICU admission may have intact neurologic survival [122, 123]. …”

Section: Neuromonitoringmentioning

confidence: 99%

“…Regarding biomarkers of a non-specific stress response, an association has been shown between high plasma glucose on admission and a poor drowning outcome [120, 123, 177]. Typically, admission plasma glucose values < 200 mg/dL were associated with better outcome.…”

Section: Biomarkersmentioning

confidence: 99%

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Brain Resuscitation in the Drowning Victim

et al. 2012

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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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Section: Neuromonitoringmentioning

confidence: 99%

Section: Neuromonitoringmentioning

confidence: 99%

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Brain Resuscitation in the Drowning Victim

et al. 2012

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“…Hypoxia remains the main predictor of outcome. [21] If the patient survives to the ED, mortality can still be ≥93%, depending on the initial presen ta tion. [5] Table 1 describes the initial clinical findings and the associated mortality rates.…”

Section: Disposition Planningmentioning

confidence: 99%

Update on drowning

Matthew

Robertson²,

Hofmeyr

2017

S Afr Med J

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An 18-year-old matriculant goes to the beach with friends to celebrate his school results. The ensuing boisterous party includes consumption of alcohol. As dusk falls, he goes for a swim with his girlfriend. She is soon seen waving frantically to their friends back on the beach. He has disappeared below the water surface. Their friends swim out, and after 10 minutes they manage to find him, and bring him to shore. They immediately start cardiopulmonary resuscitation (CPR), while calling for help. BackgroundDespite being essential to life, water, which comprises >60% of our body mass and covers >75% of the surface our planet, continues to be an occupational and recreational threat to humans. Drowning among young adults in South Africa (SA) is unfortunately especially common. Poor swimming ability due to historical lack of access to facilities, concomitant alcohol use and easy access to rivers, lakes and the ocean are all contributing factors. This is compounded by relatively limited resources to respond to drowning incidents across wide, unpatrolled areas, resulting in a growing burden of disease affecting the younger population groups in SA. Recognition of a drowning event is also a problem, as not every drowning victim will indicate their need for assistance (Fig. 1). This review examines the evidence and recommendations on drowning from an African perspective, and brings the health fraternity one step closer to developing guidelines for our country. DefinitionDrowning is defined as the process of experiencing respiratory impairment from either submersion or immersion in liquid. [1] Drowning outcomes are classified as either drowning with mortality, drowning with morbidity, or drowning without morbidity.[1] Other older terms (such as wet, dry or near drowning) have been deemed unhelpful, and have been abandoned. EpidemiologyDrowning epidemiology varies dramatically worldwide, but is notably more severe in low-to middle-income countries. US data report ~4 000 drowning deaths, 8 000 hospitalisations and 31 000 emer gency department (ED) visits per year for children ˂19 years old.[2] Regret tably, there are no consistent published data for SA, but preliminary information from Lifesaving South Africa (LSA) reveals similar trends in age demographics, although true numbers are largely unknown. [3] Extrapolation from forensic pathology data in the Western Cape provides an estimation of 4/100 000 fatal drownings per year, which is similar to the World Health Organization's estimations for low-income countries in Africa. Despite only an estimated 1 in 4 cases being reported, Africa has the highest rate of drowning in the world. [4] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Drowning is defined as the process of experiencing respiratory impairment from either submersion or immersion in liquid. Drowning morbidity and mortality are an under-recognised public health burden in southern Africa. Continuous concerted efforts are underway to improve awareness among recreational water use...

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“…These characteristics may inform strategies to prevent drownings and improve resuscitation efforts. Most epidemiologic studies of drownings are derived from European countries that border oceans and report incidence and mortality statistics, 3,5,[8][9][10][11][12][13][14] with little emphasis on the prehospital characteristics.…”

Section: Ré Sumémentioning

confidence: 99%

Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada

Buick

Lin

Rac

et al. 2014

CJEM

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Introduction: Drowning is a major public health concern, yet little is known about the characteristics of drowning patients. The objectives of this study were to describe the demographic and clinical characteristics of out-of-hospital cardiac arrest (OHCA) attributed to drowning in Ontario and to compare the characteristics of OHCA attributed to drowning to those of presumed cardiac etiology. Methods: A retrospective, observational study was carried out of consecutive OHCA patients of drowning etiology in Ontario between August 2006 and July 2011. Bivariate analysis was used to evaluate differences between drowning and presumed cardiac etiologies. Results: A total of 31,763 OHCA patients were identified, and 132 (0.42%) were attributed to drowning. Emergency medical services treated 98 patients, whereas the remaining 34 met the criteria for legislative death. Overall, 5.1% of drowning patients survived to hospital discharge. When compared to patients of presumed cardiac etiology, drowning patients were younger and their arrest was more likely to be unwitnessed, present with a nonshockable initial rhythm, occur in a public location, and receive bystander cardiopulmonary resuscitation (CPR). A nonsignificant trend was noted for drowning cases to more frequently have a public access AED applied. There were no significant differences in the gender ratio or paramedic response times. Drowning patients were more likely to be transported to hospital but had a trend to be less likely to arrive with a return of spontaneous circulation. They were also more likely to be admitted to hospital but had no difference in survival to hospital discharge. Conclusions: Significant differences exist between OHCA of drowning and presumed cardiac etiologies. Most drownings are unwitnessed, occur in public locations, and present with nonshockable initial rhythms, suggesting that treatment should focus on bystander CPR. Future initiatives should focus on strategies to improve supervision in targeted locations and greater emphasis on bystander-initiated CPR, both of which may reduce drowning mortality.

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Prognostic factors and outcome after drowning in an adult population

Abstract: The outcome is closely related to the patient's clinical status on arrival to the hospital. We have found that submersion time, age, GCS, pupillary reactivity and APACHE II at ICU admission were related to mortality. Further research in prospective studies is needed.

Cited by 23 publications

References 31 publications

Brain Resuscitation in the Drowning Victim

Brain Resuscitation in the Drowning Victim

Update on drowning

Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada

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