Mechanisms of body cooling in submersed victims

Abstract

Since the first remarkable account in 1963 [ 1 Kvittingen T.D. Naess A. Recovery from drowning in fresh water. Br Med J. 1963; 1: 1315-1317 Crossref PubMed Scopus (62) Google Scholar ], of the successful resuscitation of the 5-year-old Norwegian boy following 22 min submersion in ice-water, controversy has reigned regarding the possible mechanisms involved which facilitate the extension of our hitherto accepted injury limits of 5–7 min, for cerebral hypoxic survival. Since that early report, many other similar cases have been documented [ 2 Orlowski J.P. Drowning, near-drowning, and ice-water submersions. Ped Clin North America. 1987; 34: 75-92 PubMed Google Scholar ]; the current record for the longest accidental submersion with an intact neurological outcome—66 min in a 2 1/2-year-old girl—was reported in 1988 by Bolte et al. [ 3 Bolte R.G. Black P.G. Bowers R.S. Kent Thorne J. Correli H.M. The use of extracorporeal rewarming in a child submerged for 66 minutes. J Am Med Assoc. 1988; 260: 377-379 Crossref Scopus (181) Google Scholar ]in Salt Lake City. Regrettably, for every successful case reported there are many more with unsuccessful outcomes. One of the great dilemmas confronting those involved in the management of such victims is whether or not to continue with resuscitative procedures. Clearly, if there was some method of differentiating those with a good prognosis from those who are likely to be left with a spastic quadriplegia or similar, the decision making process would be very much easier.