Resuscitation of cold water immersion victims with cardiopulmonary bypass

Saltiel, Albert; Kopf, Gary S.; Elefteriades, John A.; Hammond, Graeme L.; Shaffer, W. B.; Farrell, Dorothy; Ponn, Ronald B.; Lister, George

doi:10.1016/0883-9441(89)90092-0

Cited by 5 publications

(2 citation statements)

References 17 publications

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“…A total of 17 papers were identified where the lung injury of drowning was the focus of the research question [ 9 , 10 , 20 – 22 , 28 – 31 , 36 , 37 , 39 , 43 , 44 , 47 , 50 , 51 , 53 ]. Twenty-four papers where the lung injury of drowning was not the focus of the research question that nevertheless included information relevant to the review were included [ 15 – 19 , 23 – 27 , 32 – 35 , 37 , 38 , 40 , 41 , 45 , 46 , 48 , 49 , 52 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

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Treatment of the lung injury of drowning: a systematic review

et al. 2021

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Background Drowning is a cause of significant global mortality. The mechanism of injury involves inhalation of water, lung injury and hypoxia. This systematic review addressed the following question: In drowning patients with lung injury, what is the evidence from primary studies regarding treatment strategies and subsequent patient outcomes? Methods The search strategy utilised PRISMA guidelines. Databases searched were MEDLINE, EMBASE, CINAHL, Web of Science and SCOPUS. There were no restrictions on publication date or age of participants. Quality of evidence was evaluated using GRADE methodology. Results Forty-one papers were included. The quality of evidence was very low. Seventeen papers addressed the lung injury of drowning in their research question and 24 had less specific research questions, however included relevant outcome data. There were 21 studies regarding extra-corporeal life support, 14 papers covering the theme of ventilation strategies, 14 addressed antibiotic use, seven papers addressed steroid use and five studies investigating diuretic use. There were no clinical trials. One retrospective comparison of therapeutic strategies was found. There was insufficient evidence to make recommendations as to best practice when supplemental oxygen alone is insufficient. Mechanical ventilation is associated with barotrauma in drowning patients, but the evidence predates the practice of lung protective ventilation. There was insufficient evidence to make recommendations regarding adjuvant therapies. Conclusions Treating the lung injury of drowning has a limited evidentiary basis. There is an urgent need for comparative studies of therapeutic strategies in drowning.

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Section: Resultsmentioning

confidence: 99%

“…Six studies [ 21 , 25 – 27 , 37 , 47 ] report on ECLS in drowning with a survival rate of 156/290 (53.7%). Fifteen studies reported on ECLS for drowning associated with accidental hypothermia [ 20 , 22 – 24 , 31 , 34 , 35 , 43 – 46 , 48 – 51 ]. The survival rate was 35/120 (29.2%).…”

Section: Resultsmentioning

confidence: 99%

Treatment of the lung injury of drowning: a systematic review

et al. 2021

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Is Cardiopulmonary Bypass Effective for Treatment of Hypothermic Arrest due to Drowning or Exposure?

et al. 1992

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Various techniques have been advocated for resuscitation from hypothermic arrest caused by ice-cold freshwater drowning or exposure. We have resuscitated five such patients after emergency hospital admission using cardiopulmonary bypass initiated via median sternotomy. All patients presented to our facility with core temperatures less than 26 degrees C. Three patients had been in full cardiopulmonary arrest for more than 30 minutes prior to arrival. The fourth patient presented in ventricular fibrillation; the fifth was admitted to the hospital in sinus bradycardia that quickly deteriorated to asystole. All had cardiopulmonary bypass emergently initiated via median sternotomy. All were rewarmed on bypass to 37 degrees C and all survived at least 24 hours. Three of the five patients are currently alive and well with normal neurologic function. Cardiopulmonary bypass is an effective technique for resuscitation after hypothermic arrest due to near drowning and/or exposure.

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