Effect of Immediate Resuscitation on Children With Submersion Injury

Abstract

Study objective. To determine the effect of immediate resuscitative efforts on the neurological outcome of children with submersion injury. Design. A case-control study was designed to determine if immediate resuscitation by rescuers or bystanders reduces the frequency of severe neurological damage or death in children with a documented submersion event. Logistic regression was used calculate an adjusted odds ratio. Participants. The study group consisted of 166 children, aged zero to 14 years, having a submersion event during May 1984 through August 1992, and admitted through various emergency departments to Huntington Memorial Hospital in Pasadena, California. Measurements and main results. All study subjects had an observed and documented episode of apnea at the time of submersion. Outcomes were evaluated on the basis of neurological impairment or death. Exposure was verified from historical accounts of postsubmersion events provided by family, friends, and/or paramedical personnel. The study factors included age and gender, duration of submersion, hypothermia, presence of apnea, resuscitative efforts, and clinical outcome. Children with a good outcome were 4.75 (adjusted odds ratio (OR)) times more likely to have a history of immediate resuscitation than children with poor outcome (95% confidence interval: 3.44 < OR < 6.06, P = .0001). Various types of resuscitative efforts and potential confounding factors were also evaluated. CPR and mouth-to-mouth resuscitation were the most effective types for the prevention of death or severe anoxic encephalopathy. Conclusion. Immediate resuscitation before the arrival of paramedical personnel is associated with a significantly better neurological outcome in children with submersion injury.

Characteristics and critical care interventions in drowning patients treated by the Danish Air Ambulance from 2016-2021: a nationwide registry-based study with 30-day follow-up

“…For the paediatric subpopulation below 6 years, the 30-day survival was 75% compared to only 22.7% in the elderly individuals above 65 years. The improved survival rates in children are consistent with other studies of paediatric emergencies [7,27,28], and drowning-related OHCA in children may be correlated with a higher rate of bystander first aid and CPR [29,30]. Also, one study indicated that paediatric drowning events were more likely to occur in swimming pools [7], which is associated with improved survival [12].…”

“…The improved survival rates in children are consistent with other studies of paediatric emergencies, [8, 23, 28] and drowning-related OHCA in children may be correlated with a higher rate of bystander rst aid and CPR. [29,30] Also, one study indicated that paediatric drowning events were more likely to occur in swimming pools, [23] which is associated with improved survival. [13] Nevertheless, drowning remains a frequent cause of HEMS dispatch in children and a leading cause of death in children.…”

“…There was no signi cant difference in total mission or response time between fatal and non-fatal drowning missions. The Danish Air Ambulance spent signi cantly more time providing medical care on-scene in the group with a fatal outcome (median [IQR] 28 [21][22][23][24][25][26][27][28][29][30][31][32] minutes vs 19 [16-29] minutes, p = 0.01). Legend: Information on 30-day follow-up was missing for 16 patients who survived prehospital due to missing CPR number.…”

Characteristics and critical care interventions in drowning patients treated by the Danish Air Ambulance from 2016 to 2021: a nationwide registry-based study with 30-day follow-up

“…For the paediatric subpopulation below 6 years, the 30-day survival was 75% compared to only 22.7% in the elderly individuals above 65 years. The improved survival rates in children are consistent with other studies of paediatric emergencies [ 7 , 27 , 28 ], and drowning-related OHCA in children may be correlated with a higher rate of bystander first aid and CPR [ 29 , 30 ]. Also, one study indicated that paediatric drowning events were more likely to occur in swimming pools [ 7 ], which is associated with improved survival [ 12 ].…”

“…There was no significant difference in total mission or response time between fatal and non-fatal drowning missions. The Danish Air Ambulance spent significantly more time providing medical care onscene in the group with a fatal outcome (median [IQR] 28 [21][22][23][24][25][26][27][28][29][30][31][32] minutes vs. 19 [16][17][18][19][20][21][22][23][24][25][26][27][28][29] minutes, p = 0.01). Most drowning missions treated by the Danish Air Ambulance occurred during the Danish summer months and public holidays of June-August (52%).…”