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Abstract

Introduction We report a case of twin toddlers who both suffered near drowning but with different post-trauma treatment and course, and different neurological outcomes. Methods and results Two twin toddlers (a boy and girl, aged 2 years and 3 months) suffered hypothermic near drowning with protracted cardiac arrest and aspiration. The girl was treated with mild hypothermia for 72 hours and developed acute respiratory dysfunction syndrome and sepsis. She recovered without neurological deficit. The boy's treatment was conducted under normothermia without further complications. He developed an apallic syndrome. Conclusion Although the twin toddlers experienced the same near drowning accident together, the outcomes with respect to neurological status and postinjury complications were completely different. One of the factors that possibly influenced the different postinjury course might have been prolonged mild hypothermia.

Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2019 Update

“…101 Our literature search yielded multiple case reports and retrospective reviews supporting neurologically intact survival in hypothermic patients, but several older studies showed no benefit. 102 –114 There is no prospective study comparing TH to normothermia after ROSC in drowning patients. There might be benefit to discontinuing rewarming interventions after a hypothermic drowning patient has reached TH temperature range, but this has been insufficiently studied to support an evidence-based recommendation.…”

Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Drowning

“…79 Our literature search yielded multiple case reports and retrospective reviews supporting neurologically intact survival in hypothermic patients, but several older studies showed no benefit. [80][81][82][83][84][85][86][87][88][89][90][91][92] There are no prospective studies comparing TH with normothermia after ROSC in drowning patients. There may be benefit to discontinuing rewarming interventions after a hypothermic drowning patient has reached TH temperature range, but this has been insufficiently studied to support an evidence-based recommendation.…”

Brain Resuscitation in the Drowning Victim

“…2 LOE 3 studies showing neutral effects [85, 296], 1 LOE 4 report indicating benefit [297], 1 LOE 4 report indicating a neutral effect [298], and 7 LOE 4 studies for which the effect was not specified [184, 266, 299-303]. These studies were all in drowning.…”