Brain Resuscitation in the Drowning Victim

Abstract

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.

Cardiopulmonary Resuscitation Quality by Helicopter Rescue Swimmers While Flying

“…In drowning cases, immediate and continued good quality CPR with emphasis not only on chest compression (CC) but also on rescue ventilations is essential to achieve the best possible neurologic outcome. 2,3 Considering the potential advantages of air transport, most countries have implemented helicopter emergency services. 4 Helicopter transport contributes to reducing the time to reach the hospital and expediting the application of critical interventions like CPR.…”

Update on drowning

“…An initial arterial blood gas measurement may be useful in determining the titration of oxygenation and the need for ventila tion. [18] Despite early animal evidence demonstrating pathophysiological differ ences in salt-and freshwater drowning, this has not been clearly distinguished in humans. [19] Electrolyte abnormalities and changes in osmolarity only occur when >11 -22 mL/kg of water are aspirated, while studies show that in human drowning ~3 -4 mL/kg are aspirated.…”

“…[19] Electrolyte abnormalities and changes in osmolarity only occur when >11 -22 mL/kg of water are aspirated, while studies show that in human drowning ~3 -4 mL/kg are aspirated. [18] Therefore, the role of routine electrolyte testing is questionable.…”

Veterinary Forensic Pathology

“…23,62 The precise outcome of hypoxic injury due to drowning is difficult to predict even if the individual is rescued and resuscitated. 87 Cold Water Immersion, Autonomic Conflict, and Hypothermia…”