Abstract
Drowning is one of the leading causes of accidental deaths in children worldwide. However, the use of long-term extracorporeal life support (ECLS) in this setting is not widely established, and rewarming is often achieved by short-term cardiopulmonary bypass (CPB) treatment. Thus, we sought to add our experience with this means of support as a bridge-to-recovery or to-decision. This retrospective single-center study analyzes the outcome of 11 children (median 23 months, minimum-maximum 3 months-6.5 years) who experienced drowning and subsequent cardiopulmonary resuscitation (CPR) between 2005 and 2016 and who were supported by veno-arterial extracorporeal membrane oxygenation (ECMO), CPB, or first CPB then ECMO. All but one incident took place in sweet water. Submersion time ranged between 10 and 50 minutes (median 23 minutes), water temperature between 2°C and 28°C (median 14°C), and body core temperature upon arrival in the emergency department between 20°C and 34°C (median 25°C). Nine patients underwent ongoing CPR from the scene until ECMO or CPB initiation in the operating room. The duration of ECMO or CPB before successful weaning/therapy withdrawal ranged between 2 and 322 hours (median 19 hours). A total of four patients (36%) survived neurologically mildly or not affected after 4 years of follow-up. The data indicate that survival is likely related to a shorter submersion time and lower water temperature. Resuscitation of pediatric patients after drowning has a poor outcome. However, ECMO or CPB might promote recovery in selected cases or serve as a bridge-to-decision tool.
Highlights
Drowning is one of the leading causes of accidental death in children worldwide.[1,2,3] The process of drowning leads to respiratory impairment by water entering the airways and to hypothermia, resulting in unconsciousness and cardiac arrest due to hypoxia.[4,5]For the isolated purpose of rewarming, cardiopulmonary bypass (CPB) is commonly applied after drowning in children,[6,7] whereas extracorporeal life support (ECLS) treatment alone or combined with CPB is not used as frequently.[7,8] Most observations and recommendations are based on case reports, mixed series with adults, or on multi-institutional experience
Patient characteristics at the scene and early emergency service support Two children fell into freezing lake or pond water during the winter, whereas two others experienced drowning in a warm pool
There is still no uniform treatment concept for pediatric drowning patients with prolonged resuscitation arriving in the emergency department (ED)
Summary
Drowning is one of the leading causes of accidental death in children worldwide.[1,2,3] The process of drowning leads to respiratory impairment by water entering the airways and to hypothermia, resulting in unconsciousness and cardiac arrest due to hypoxia.[4,5]For the isolated purpose of rewarming, cardiopulmonary bypass (CPB) is commonly applied after drowning in children,[6,7] whereas extracorporeal life support (ECLS) treatment alone or combined with CPB is not used as frequently.[7,8] Most observations and recommendations are based on case reports, mixed series with adults, or on multi-institutional experience. Veno-arterial and veno-venous extracorporeal membrane oxygenation (ECMO) may be used for few days up to several weeks.[10] According to recent studies, ECLS might be a promising, resuscitative strategy for patients after drowning.[11,12] Burke et al.[13] examined retrospective data from the Extracorporeal Life Support Organization (ELSO) registry to determine the outcomes of ECLS and risk factors for death in pediatric drowning victims Their data suggests that survival is higher in those patients cannulated onto ECLS without prior cardiopulmonary resuscitation (CPR) compared to those cannulated with ECPR (71% vs 23% survival, respectively). They identified ECLS placement during CPR, veno-arterial ECMO mode, renal failure, and CPR on ECLS as risk factors for mortality
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
