Abstract
Introduction
Drowning results in more than 360,000 deaths annually, making it the 3rd leading cause
of unintentional injury death worldwide. Prior studies have examined airway interventions
affecting patient outcomes in cardiac arrest, but less is known about drowning patients
in arrest. This study evaluated the outcomes of drowning patients in the Cardiac Arrest
Registry to Enhance Survival (CARES) who received advanced airway management.
Methods
A retrospective analysis of the CARES database identified cases of drowning etiology
between 2013 and 2018. Patients were stratified by airway intervention performed by
EMS personnel. Demographics, sustained return of spontaneous circulation [ROSC], survival
to hospital admission, survival to hospital discharge, and neurological outcomes were
compared between airway groups using chi-squared tests and logistic regression.
Results
Among 2388 drowning patients, 70.4% were male, 41.8% white, and 13.1% survived to
hospital discharge. Patients that received supraglottic airways [SGA] had statistically
significantly lower odds of survival to hospital admission compared to endotracheal
tube [ETT] use (adjusted odds ratio [aOR] = 0.56, 95% confidence interval [CI] 0.42–0.76)
as well as lower odds of survival to discharge compared to bag valve mask [BVM] use
(aOR = 0.40, 95% CI 0.19−0.86) when accounting for relative ROSC timing.
Conclusion
In this national cohort of drowning patients in cardiac arrest, SGA use was associated
with significantly lower odds of survival to hospital admission and discharge. However,
survival to discharge with favorable neurological outcome did not differ significantly
between airway management techniques. Further studies will need to examine if airway
intervention order or time to intervention affects outcomes.
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 fact sheet.W.H.O., 2018 (Accessed 25 May 2020, at https://www.who.int/news-room/fact-sheets/detail/drowning)
- Web-based injury statistics query and reporting system (WISQARS).2012 (Accessed 25 May 2020, at http://www.cdc.gov/injury/wisqars)
- 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
- Submersion injuries in the United States: patient characteristics and predictors of mortality and morbidity.Injury. 2018; 49: 543-548
- 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
- Review of 14 drowning publications based on the Utstein style for drowning.Scand J Trauma Resusc Emerg Med. 2018; 26: 19
- Predicting outcome of drowning at the scene: a systematic review and meta-analyses.Resuscitation. 2016; 104: 63-75
- Predictors of emergency department discharge following pediatric drowning.Am J Emerg Med. 2018; 36: 446-449
- Predictors of safe discharge for pediatric drowning patients in the emergency department.Am J Emerg Med. 2018; 36: 1619-1623
- Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial.JAMA. 2018; 320: 779-791
- Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest.Resuscitation. 2012; 83: 1061-1066
- Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: a meta-analysis.Resuscitation. 2015; 93: 20-26
- Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest.JAMA. 2013; 309: 257-266
- Failure to ventilate with supraglottic airways after drowning.Anaesth Intensive Care. 2011; 39: 675-677
- Data dictionary; 2019.(Accessed 20 May 2020 at https://mycares.net/sitepages/uploads/2019/Data%20Dictionary%20(2019).pdf)2019
- 2015 Revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: an ILCOR advisory statement.Resuscitation. 2017; 118: 147-158
- Drowning.N Engl J Med. 2012; 366: 2102-2110
- Outcome of conventional bystander cardiopulmonary resuscitation in cardiac arrest following drowning.Prehosp Disaster Med. 2020; 35: 141-147
- Out-of-hospital cardiac arrest due to drowning among children and adults from the Utstein Osaka Project.Resuscitation. 2013; 84: 1568-1573
- Bystander CPR is associated with improved neurologically favourable survival in cardiac arrest following drowning.Resuscitation. 2017; 115: 39-43
- Characteristics of drowning by different age groups.Inj Prev. 2003; 9: 163-168
- Airway management and out-of-hospital cardiac arrest outcome in the CARES registry.Resuscitation. 2014; 85: 617-622
- Resuscitation time bias” — a unique challenge for observational cardiac arrest research.Resuscitation. 2018; 125: 79-82
- Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after out-of-hospital cardiorespiratory arrest.JAMA. 2018; 319: 779-787
- The role of prehospital advanced airway management on outcomes for out-of-hospital cardiac arrest patients: a meta-analysis.Am J Emerg Med. 2016; 34: 2101-2106
- Out-of-hospital airway management and cardiac arrest outcomes: a propensity score matched analysis.Resuscitation. 2012; 83: 313-319
- The impact of airway strategy on the patient outcome after out-of-hospital cardiac arrest: a propensity score matched analysis.Eur Heart J Acute Cardiovasc Care. 2018; 7: 423-431
- Comparing effectiveness of initial airway interventions for out-of-hospital cardiac arrest: a systematic review and network meta-analysis of clinical controlled trials.Ann Emerg Med. 2020; 75: 627-636
- Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of prehospital cardiac arrest (REVIVE-Airways): a feasibility study research protocol.BMJ Open. 2013; 3e002467
- Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial.JAMA. 2018; 320: 779-791
Article info
Publication history
Published online: January 19, 2021
Accepted:
December 23,
2020
Received in revised form:
December 12,
2020
Received:
July 9,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
