Abstract
Aim
Neuroprotective effects of hypothermia may explain surprisingly high survival rates
reported after drowning in cold water despite prolonged submersion. We described a
cohort of refractory hypothermic cardiac arrests (CA) due to drowning treated by extracorporeal
life support (ECLS) and aimed to identify criteria associated with 24-h survival.
Methods
Eleven-year period (2002–2012) retrospective study in the surgical intensive care
unit (ICU) of a tertiary hospital (European Hospital Georges Pompidou, Paris, France).
All consecutive hypothermic patients admitted for refractory CA after drowning in
the Seine River were included. Patients with core temperature below 30 °C and submersion duration of less than 1 h were potentially eligible for ECLS resuscitation.
Results
Forty-three patients were admitted directly to the ICU during the study period. ECLS
was initiated in 20 patients (47%). Among these 20 patients, only four (9%) survived
more than 24 h. A first hospital core temperature ≤26 °C and a potassium serum level between 4.2 and 6 mM at hospital admission have a sensitivity of 100% [95%CI: 28–100%] and a specificity
of 100% [95%CI: 71–100%] to discriminate patients who survived more than 24 h. Overall survival at ICU discharge and at 6-months was 5% [95%CI: 1–16%] (two patients).
Conclusions
Despite patient hypothermia and aggressive resuscitation with ECLS, the observed survival
rate is low in the present cohort. Like existing algorithms for ECLS management in
avalanche victims, we recommend to use first core temperature and potassium serum
level to indicate ECLS for refractory CA due to drowning.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Drowning N Engl J Med. 2012; 366: 2102-2110
- Drowning: update 2009.Anesthesiology. 2009; 110: 1390-1401
- Drowning: a cry for help.Anesthesiology. 2009; 110: 1211-1213
- Brain resuscitation in the drowning victim.Neurocrit Care. 2012; 17: 441-467
- Out-of-hospital cardiac arrest due to drowning among children and adults from the Utstein Osaka Project.Resuscitation. 2013; 84: 1568-1573
- Neurocognitive long term follow-up study on drowned children.Resuscitation. 2014; 85: 1059-1064
- Out-of-hospital cardiac arrest due to drowning: an Utstein Style report of 10 years of experience from St Mary's Hospital.Resuscitation. 2009; 80: 778-783
- Drowning related out-of-hospital cardiac arrests: characteristics and outcomes.Resuscitation. 2013; 84: 1114-1148
- Characteristics of lifesaving from drowning as reported by the Swedish Fire and Rescue Services 1996–2010.Resuscitation. 2012; 83: 1072-1077
- A proposed decision-making guide for the search, rescue and resuscitation of submersion (head under) victims based on expert opinion.Resuscitation. 2011; 82: 819-824
- Cold stress, near drowning and accidental hypothermia: a review.Aviat Space Environ Med. 2000; 71: 733-752
- Immersion, near-drowning and drowning.Br J Anaesth. 1997; 79: 214-225
- Survival after 40 minutes; submersion without cerebral sequeae.Lancet. 1975; 1: 1275-1277
- Recovery from drowning in fresh water.Br Med J. 1963; 1: 1315-1317
- Recovery from profound hypothermia with cardiac arrest after immersion.Br Med J. 1973; 4: 394-395
- European Resuscitation Council Guidelines for Resuscitation 2010 Section 8 Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution.Resuscitation. 2010; 81: 1400-1433
- Accidental hypothermia.N Engl J Med. 2012; 367: 1930-1938
- Outcome from severe accidental hypothermia with cardiac arrest resuscitated with extracorporeal cardiopulmonary resuscitation.Am J Emerg Med. 2014; 32: 320-324
- Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest.J Thorac Cardiovasc Surg. 2007; 134: 594-600
- Rewarming from accidental hypothermia by extracorporeal circulation. A retrospective study.Eur J Cardiothorac Surg. 2001; 20: 58-64
- Outcome from severe accidental hypothermia in Southern Finland – a 10-year review.Resuscitation. 2003; 59: 285-290
- Nobody is dead until warm and dead: Prolonged resuscitation is warranted in arrested hypothermic victims also in remote areas – A retrospective study from northern Norway.Resuscitation. 2014; 85: 1204-1211
- Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming.N Engl J Med. 1997; 337: 1500-1505
- Prognostic markers in patients with severe accidental hypothermia and cardiocirculatory arrest.Resuscitation. 1994; 27: 47-54
- Outcome of drowned hypothermic children with cardiac arrest treated with cardiopulmonary bypass.Acta Anaesthesiol Scand. 2010; 54: 1276-1281
- Outcome of 12 drowned children with attempted resuscitation on cardiopulmonary bypass: an analysis of variables based on the Utstein style for drowning.Resuscitation. 2007; 75: 42-52
- Outcome of accidental hypothermia with or without circulatory arrest: experience from the Danish Præstø Fjord boating accident.Resuscitation. 2012; 83: 1078-1084
- European Resuscitation Council Guidelines for Resuscitation 2010 Section 1 Executive summary.Resuscitation. 2010; 81: 1219-1276
- Resuscitation of avalanche victims: evidence-based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM): intended for physicians and other advanced life support personnel.Resuscitation. 2013; 84: 539-546
- The Seldinger technique: 50 years on.Lancet. 2005; 366: 1407-1409
- Drowning associated pneumonia: a descriptive cohort.Resuscitation. 2012; 83: 399-401
- Recommended guidelines for uniform reporting of data from drowning: the Utstein style.Circulation. 2003; 108: 2565-2574
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).Circulation. 2004; 110: 3385-3397
- High frequency oscillatory ventilation associated with cardiopulmonary bypass in the management of drowning and deep hypothermia.JEUR. 2005; 18: 100-101
- Mechanisms of body cooling in submersed victims.Resuscitation. 1997; 35: 107-109
- Extracorporeal life support following out-of-hospital refractory cardiac arrest.Crit Care. 2011; 15: R29
Article info
Publication history
Published online: December 04, 2014
Accepted:
November 21,
2014
Received in revised form:
November 19,
2014
Received:
August 29,
2014
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
