The Use of Extracorporeal Rewarming in a Child Submerged for 66 Minutes

Abstract

A 2 1/2-year-old girl had a good neurologic recovery after submersion in cold water for at least 66 minutes; as far as we know, this is the longest time ever reported. Cardiopulmonary resuscitation was maintained for more than two hours before the initiation of extracorporeal rewarming in this child who had a core temperature of 19 degrees C. To our knowledge, this is the first successful use of extracorporeal rewarming in a child suffering from accidental hypothermia. Extension of this technique to children offers rapid rewarming and cardiovascular support for pediatric victims of severe hypothermia. We emphasize the importance of a coordinated response by the entire emergency medical system integrated with hospital-based personnel. Where it is geographically feasible, regionalization of triage and care for the pediatric victim of severe accidental hypothermia should be considered.

Part 12: Cardiac Arrest in Special Situations

“…461 To aid in use of consistent terminology and uniform reporting of data, use of the Utstein definitions and style of data reporting specific to drowning is recommended. 462,463 Although survival is uncommon in victims who have undergone prolonged submersion and require prolonged re suscitation, 464,465 successful resuscitation with full neurolog ical recovery has occurred occasionally after prolonged sub mersion in icy water [466][467][468][469] and, in some instances, warm water. 470,471 For this reason, scene resuscitation should be initiated and the victim transported to the ED unless there is obvious death (eg, rigor mortis, decomposition, hemisection, decapitation, lividity).…”

“…479 -482 The use of extracorporeal membrane oxygenation in patients with severe hypothermia after submersion has been documented in case reports. 468 Injuries from electric shock and lightning strike result from the direct effects of current on the heart and brain, cell membranes, and vascular smooth muscle. Additional injuries result from the conversion of electric energy into heat energy as current passes through body tissues.…”

Part 10.3: Drowning

“…14 -16 The use of extracorporeal membrane oxygenation in young children with severe hypothermia after submersion is documented in case reports. 8,17 There is insufficient evidence to support or refute the use of barbiturates, steroids, 18 nitric oxide, 19 therapeutic hypothermia after return of spontaneous circulation, 20 …”

Sports related to drowning

“…Duration of resuscitation varied from 0-180 min until spontaneous heart rate and blood pressure were obtained. The longest documented submersion with good outcome was 66 min in a 2.5-year-old girl, and required >140 min of resuscitation [27]. The longest estimated submersion time was >83 min in a 7-year-old girl who required 64 min of CPR [28].…”