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

Abstract

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.

Can we identify termination of resuscitation criteria in cardiac arrest due to drowning: results from the French national out‐of‐hospital cardiac arrest registry

“…About half of the study population benefited from a BLS provided by a witness before professional first aid provider arrival (41.9% had chest compression and 17.9% had ventilation). The median no flow duration (time interval between cardiac arrest and first cardiopulmonary resuscitation) was 10 minutes. First aid providers (usually firemen or lifeguards) initiated a BLS in 85.0% of cases before MMT arrival (median response time 10 minutes).…”

“…Our study also confirms some previous investigations concerning the outcome predictive factors timings (MMT response time or no flow duration) . However, this work outlines the necessity of an organized quick and high quality BLS . Indeed, we shown that an immediate care by witnesses (a short no flow duration) is a sine qua none condition to survive with a good neurological outcome.…”

“…The initiation of a prompt BLS was also quicker and more frequently recorded in this population. Indeed, 55.8% of patients alive at admission had an immediate BLS versus only 18.7% of the others (P < 0.001), and the median no flow duration was shorter for patients alive at hospital admission (6 [0-11] vs 12.5 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] minutes; P < 0.001). Alive patients were more often under chest compression and ventilated by witnesses than victims who died before their hospital admission (respectively 61.1% vs 28.8%; P < 0.001 and 34.7% vs 6.5%; P < 0.001).…”

“…The time to get out of water and the effectiveness of implemented resuscitation are key survival factors. A large amount of literature deals with the description of cardiac arrest after drowning (CAD) and their management [5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. However, most of the articles are case reports [9,17,19,22] or studies with long inclusion periods designed to reach a sufficient sample size [12,15,18,20,[23][24][25].…”

Review of 14 drowning publications based on the Utstein style for drowning

“…After exclusion of drowning publications that did not explicitly mention that data collection was based on the USFD parameters, eight USFD based drowning publications remained [ 3 – 10 ]. Of the 29 publications that had not used the USFD, three were drowning publications of which data collection was based on the Utstein style for out of hospital cardiac arrest [ 20 , 21 ], or did not describe the use of any Utstein template [ 22 ], four were publications on resuscitation that included only a few drowning patients [ 23 – 26 ], one was a resuscitation publication that excluded drowning victims [ 27 ], five were reviews [ 28 – 32 ], and 16 were other types of publications (definition of drowning, editorials, abstracts, letter to the editor, non-English language articles, post mortem examinations, book chapter) [ 33 – 48 ].

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