Duration Of Submersion Research Articles

Refractory dystonia with intracerebral hematoma after drowning

Drowning in children can have devastating consequences. The risk factors are inadequate supervision, seizure disorder, neurodevelopmental disorder, and cardiovascular disease. The duration of submersion is critical in determining outcomes. The lack of consensus guidelines on pediatric submersion injuries invites difficulty in managing the same. There is a lack of robust evidence on therapeutic hypothermia and, the use of pulmonary surfactants and barbiturates to improve clinical outcomes in such injuries. We present a case of a drowned child in cardiac arrest revived after resuscitation, developing sepsis, seizures, severe dystonia, and intracranial bleeding with hypoxic brain injury requiring vigorous management.

Simultaneous Presentation of Swimming-Induced Pulmonary Edema in a Set of Monozygotic Twin Elite Maritime Warfare Candidates: A Novel Case Report.

Swimming-induced pulmonary edema (SIPE) is an incompletely understood condition that is often seen in U.S. special operations candidates participating in maritime qualification training courses. We present a case of two monozygotic twins with the simultaneous onset of acute respiratory distress during a crucible event of a maritime assessment and selection course. Subsequent pulmonary ultrasonography in both candidates showed wedge-shaped hyperechoic lines (B-lines) extending from the pleural interface into the interstitium. Chest radiography of both candidates revealed bilateral asymmetric hazy opacities consistent with SIPE. Both candidates recovered with supportive measures but were medically removed from training. Given the near-identical exposures of the candidates to the same ambient and water temperatures, duration of water submersion, magnitude of physical stressors, and viral colonization, this case study suggests that there may be underlying genetic factors, in addition to environmental factors, that predispose individuals to developing SIPE. Further benchtop and clinical research must be performed to identify potential genetic polymorphisms that contribute to the development of SIPE and to investigate safe interventions that address the underlying etiologies of SIPE pathophysiology.

Feasibility study of the Utstein Style For Drowning to aid data collection on the resuscitation of drowning victims

AimThe revised Utstein Style For Drowning (USFD) was published in 2015. Core data were considered feasible to be reported in most health systems worldwide. We aimed to determine the suitability of the USFD as a template for reporting data from drowning research. MethodClinical records of 437 consecutive drowning presentations to the Sunshine Coast Hospital and Health Service Emergency Departments (ED) between 1/1/2015 and 31/12/2021 were examined for data availability to complete the USFD. The proportions of patients with each variable documented is reported. Time taken to record core and supplementary variables was recorded for 120 consecutive patients with severity of drowning Grade 1 or higher. ResultsThere were 437 patients, including 227 (51.9%) aged less than 16 years. There were 253 (57.9%) males and 184 (42.1%) females. Sixty-one patients (13.9%) received cardiopulmonary resuscitation (CPR). There were nine (2.1%) deaths after presentation to the ED. Median time for data entry was 17 minutes for core variables and 6 min for supplementary. This increased to 29 + 6 minutes for patients in cardiac arrest. Sixteen (32.7%) of 49 core variables and four (13.3%) of 30 supplementary variables were documented 100% of the time. One (2.0%) core and seven (23.3%) supplementary variables were never documented. Duration of submersion was documented in 100 (22.9%) patients. ConclusionUSFD is time consuming to complete. Data availability to enable completion of the USFD varies widely, even in a resource rich health system. These results should be considered in future revisions of the USFD.

A spatio-temporal analysis of marine diatom communities associated with pristine and aged plastics

Complex microbial communities colonize plastic substrates over time, strongly influencing their fate and potential impacts on marine ecosystems. Among the first colonizers, diatoms play an important role in the development of this ‘plastiphere’. We investigated 936 biofouling samples and the factors influencing diatom communities associated with plastic colonization. These factors included geographic location (up to 800 km apart), duration of substrate submersion (1 to 52 weeks), plastics (5 polymer types) and impact of artificial ageing with UV light. Diatom communities colonizing plastic debris were primarily determined by their geographic location and submersion time, with the strongest changes occurring within two weeks of submersion. Several taxa were identified as early colonizers (e.g. Cylindrotheca, Navicula and Nitzschia spp.) with known strong adhesion capabilities. To a lesser extent, plastic-type and UV-ageing significantly affected community composition, with 14 taxa showing substrate-specificity. This study highlights the role of plastics types-state for colonization in the ocean.

Erosion and accretion patterns on intertidal mudflats of the Yangtze River Estuary in response to storm conditions

Understanding of erosion and accretion patterns over intertidal mudflats during storm periods is vital for the management and sustainable development of coastal areas. This study aimed to investigate the effect of the 2014 storm Fung-wong on the erosion and accretion patterns of the Nanhui intertidal mudflats in the Yangtze estuary, China, based on field measurements and Delft3D numerical modeling. Results show that prolonged easterly winds during the storm enhance the flood velocity, weaken the ebb velocity, and even change the current direction. The current velocity, wave heights, and bed-level changes increased by 1–1.43 times, 2.40–3.88 times, and 2.28–2.70 times than those of normal weather, respectively. The mudflats show a spatial pattern of overall erosion but increasing erosion magnitude from the high (landward) mudflat to the low (seaward) mudflat during the storm. The magnitude of bed-level change increases with increasing wind speed, but the spatial pattern of erosion and accretion remains the same. The main reason for this pattern is the longer submersion duration of the low mudflat compared with the high mudflat, so the hydrodynamic process is longer and stronger, leading to an enhancement in bed shear stress and sediment transport rate. Wind speed increases the hydrodynamic intensity but does not affect on the submersion duration over each part of the intertidal mudflat. This study is helpful to improve the understanding of physical processes during storms on intertidal mudflats and provides a reference for their protection, utilization, and management, as well as for research in related disciplines.

Critical care drowning admissions in Southwest England 2009-2020, a retrospective study.

In the United Kingdom (UK), 600 deaths per annum are attributable to drowning. Despite this there is scarce critical care data on drowning patients globally. We describe drowning cases admitted to critical care units with a focus on functional outcomes. Medical records for critical care admissions following a drowning event were retrospectively reviewed across six hospitals in Southwest England for cases presenting in the period between 2009 and 2020. Data was collected according to the Utstein international consensus guidelines on drowning. Forty-nine patients were included, 36 males and 13 females, including seven children. Median submersion duration was 2.5min 20 cases were in cardiac arrest when rescued. At discharge 22 patients had preserved functional status, 10 patients had a reduced functional status. 17 patients died in hospital. Admission to critical care following drowning is uncommon and associated with high rates of mortality and poor functional outcomes. We find that 31% of those who survived a drowning event subsequently required an increased level of assistance with their activities of daily living.

Thermal regime variability of islands in the Lena River near Yakutsk, eastern Siberia

AbstractRecent evidence has shown that Arctic regions have warmed about twice as much as elsewhere on the planet over the last few decades, and that high‐latitude permafrost–periglacial processes and hydrological systems are notably responsive to rising temperatures. The aim of this paper is to report on the thermal regime of islands located along the Lena River floodplain, upstream of the city of Yakutsk (eastern Siberia). Four islands were monitored using waterproof dataloggers and continuous monitoring of frozen soil in contact with ice breakup of the Lena River. For each of these islands, we measured: (a) ground surface temperature, air and frozen soil temperatures at different depths; and (b) submersion duration during the flood. Our results show that within a zone of thick and continuous permafrost, the Lena floodplain is notably heterogeneous, with a combination of permanently and seasonally frozen islands. The ice breakups seem to have a negligible impact on the ground thermal regime. Our study confirms that relatively young (<30 years old) islands, composed of fine sand material, appear less prone to permafrost formation compared to older islands with ice‐rich silty material.

Grey seal Halichoerus grypus breeding sites contribute substantial carrion biomass to the Firth of Forth

Decomposing organic matter is central to the recycling of energy and nutrients in all ecosystems. Few studies have investigated the role of animal carrion biomass in ecosystem functioning, and quantitative data on carrion biomass are lacking. The role of carrion inputs in the marine environment specifically is poorly understood. The grey seal Halichoerus grypus breeding colony on the Isle of May in the Firth of Forth, Scotland, provides insight into the contribution of regular carrion pulses to the surrounding marine ecosystem. This study analysed 3 breeding locations with a range of topographies, elevations and tidal influences. Carcasses were mapped from aerial images and ground visual surveys in the 2008 and 2012 breeding seasons. Generalised linear mixed models were used to explore the degree to which breeding location and the position of a carcass influenced its availability to marine scavengers. Carcasses closer to shore were more likely to be completely displaced to the marine environment, and this effect varied with breeding location. An approximate 0.9 to 1.3 t of biomass per hectare of breeding site per year were released into the marine system. For carcasses that were below the high-water spring tide range but remained on shore, we quantified the typical duration of submersion to range from 5% to 44% of the time carcasses were ashore. Additionally, up to 808 kg of carrion was accessible to marine scavengers while washed by tides. Our results suggest breeding colonies of grey seals may contribute significantly to the carrion biomass available in local marine systems.

Epidemiology of Drowning Incidents among Children at Sultan Qaboos University Hospital Oman.

ObjectivesWe sought to study the epidemiology of drowning among children reported at Sultan Qaboos University Hospital in Oman.MethodsWe conducted a retrospective study of the patients who presented to the emergency department with a history of drowning over 10 years from January 2008 to December 2017. Patients with children aged one to 18 years old were included in the study. The data including demographics, timing and location of drowning, season, adult supervision, swimming ability, medical risk factors, duration of submersion, on spot resuscitation, emergency medicine department assessment, and hospital management and outcome were collected from electronic hospital information system using a preformed proforma. The outcome was categorized into either full recovery, severe neurological injury, or brain death based on the pediatric cerebral performance category (PCPC). A good outcome represents a score of 1–3 points, and a PCPC of 4–6 points corresponds to a poor outcome. We calculated correlation for all variables with the outcome by using chi-square and Fisher’s exact tests. A p-value of < 0.050 is taken as significant value.ResultsA total of 74 patients were included in the study; 54 (73.0%) were male, and 47 (63.5%) were aged < 6 years old. More than half (59.4%) of drownings happened in swimming pool, 21 (28.4%) children were unsupervised during the incident, and 39 (52.7%) required cardiopulmonary resuscitation (CPR). Out of all studied subjects, three (4.1%) were brain dead, and two (2.7%) developed severe neurological injury. On univariate analysis, the following variables were statistically significant (p < 0.050), predicting the poor outcome like lack of adult supervision, duration of submersion >10 minutes, asystole, Glasgow Coma Scale < 8, temperature < 35 oC, pH < 7, anion gap > 20, blood glucose > 10 mmol/L, abnormal chest X-ray findings, rewarming, CPR, intubation, inotropic support, and pediatric intensive care unit admission.ConclusionsOur study suggests that children, especially males under the age of six with no swimming ability, need strict supervision next to bodies of water. Furthermore, preventive measures might include raising community awareness about the risk factors of drowning, commencing public CPR lessons, and strict pool safety regulation by related authorities.

Bioavailabilitas Mineral Ca (in vitro) pada Jagung (Zea mays L), dengan Penambahan Asam Sitrat dan Fitase Bacilus subtilis HG

Abstract. Background &amp; Aims: Mineral Ca is the most abundant mineral in the human body. Lack of mineral Ca in the human body in the long term will result in loss and calcification. Corn is food ingredient that contains vegetable calcium, it is widely consumed by Indonesians. The purpose of the research to obtain information on the bioavailability of the mineral Ca (in vitro) in corn (Zea mays L) with the addition of citric acid and phytase’s Basillus subtilis HG isolate.Methods: The research consists of two steps. The first step is to determine the best treatment in reducing phytate acid in corn with variations of the submersion duration and the citric acid concentrate, with the variation of phytase enzyme concentrations. The second step is to determine the bioavailability of mineral Ca through in vitro proses. The data analysis used two way anova and one away anova.Results: The results of the research: 1) the best treatment to reduce phytate acid in found in the immersion of corn with 9% citric acid for 12 hours in the amount of 32.45%, whereas in the variation of the concentration of phytase enzyme 250µL/50mL in the amount 50.09%. 2) The highest bioavailability of mineral Ca through in vitro is in amount of 56.880% with 9% citric acid for 12 hours and with the increment of phytase enzyme 250µL/50mL.Conclusion: The increase in bioavailability of mineral Ca in corn (Zea mays L) was influenced by the addition of citric acid concentration, submersion duration, and the concentration of phytase enzyme. Research on mineral bioavailability can be further developed by examining other foodstuffs containing phytate acid, and carried out by more sophisticated methods and analyzed, and the methods that have been done can be used to study the degradation of phytate to other bivalent minerals.Keywords: bioavailability of mineral Ca; phytate acid; citric acid; phytase

Temporal changes of a fouling community: Colonization patterns of the benthic epifauna in the shallow northern Adriatic Sea

Sessile benthic communities are an important element of marine ecosystems, yet their temporal patterns remain poorly understood. For this reason, the temporal changes of the fouling community on brick plates in Piran Bay, Gulf of Trieste (northern Adriatic Sea), were studied for two calendar years. The aim of this study was to identify the settlement of dominant native and alien species on artificial substrates and their temporal occurrence, both in terms of season and duration of submersion. In addition, we tried to assess the impact of the placement period on developing communities. The dominant taxonomic groups were bryozoans, which accounted for almost half of the total coverage (46%), serpulid polychaetes (25%) and bivalves (11%). Most of the species belonging to the dominant taxa occurred throughout the year, with the peak of occurrence in summer. The first settlers included serpulids and bivalves, which were constantly found on the plates together with bryozoans. Alien and cryptogenic species represented about 13% of all taxa found during the study. This highlights the importance of bare artificial structures erected outside typical hotspots for alien species; they serve as a springboard for the spread of alien fouling species. The communities that formed on plates placed in different seasons showed significant differences between them. High bryozoan coverage characterized the communities placed in winter and spring, while the plates placed in summer and autumn were dominated by serpulid polychaetes. These differences are the result of species seasonality as well as the interaction between them. The study demonstrates the importance of timing for initial colonization. It can be linked to the placement of the bare substrate for the development of the community, and provides a baseline for research and projects involving underwater constructions and the detection of alien species.

Effect of Citric Acid on Color Changes of Calcium Silicate-Based Cements an In Vitro Study

The aim of the present in vitro study was to investigate the effects of 10% and 40% citric acid (CA) on the color of calcium silicate–based cements (CSCs) in comparison to the effects of common root canal irrigants. Samples of six CSCs (n = 6)—ProRoot MTA (Dentsply, Tulsa, OK, USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), MTA Plus (Avalon Biomed Inc, by Prevest Denpro Limited, Jammu, India), MTA Repair HP (Angelus, Londrina, PR, Brazil), Ortho MTA (BioMTA, Seoul, Korea), and Retro MTA (BioMTA, Seoul, Korea)—were immersed in 10% and 40% CA as well as 15% EDTA, 2% NaOCl, 2% CHX, and 0.9% NaCl for 15 min, 1 h, and 24 h. ΔE values, representing the difference between the final and baseline values of the color components, were then determined using a VITA Easyshade Compact 5.0 spectrophotometer. Naked-eye evaluation of the changes in color and structures of the materials was performed using our own scale. Upon immersion of the materials in both 10% and 40% CA, there were statistically significant differences between spectrophotometric color measurement results for all CSCs (P &lt; 0.05). However, CA does not cause dark discoloration, observable with the naked eye, of any of the materials, such as NaOCl and CHX. Significant statistical differences were also found between all CSCs in terms of submersion duration (P &lt; 0.05). CA, which could be an alternative to EDTA use, caused greater CSCs discoloration and changed some of their structures. Unless required by the therapeutic procedure, clinicians should pay attention to the fact that the irrigant may affect the CSCs discoloration and minimize the contact time of irrigant with CSCs.

Studying outcome predictors of drowning at the scene: Why do we have so few answers?

Identification of predictors of outcome at the scene of drowning events could guide prevention, care and resource utilization. This review aimed to describe where, what and how scene predictive factors have been evaluated in drowning outcome studies. We reviewed studies reporting scene drowning predictors published between 2003 and 2019. Data extraction included study populations, data sources, predictor factors (victim, incident, rescue, resuscitation and hospital-related), outcome measures and type of analyses. Of 49 studies, 87.6% were from high-income countries, 57.1% used data from only one source (92.9% of these from either hospital or EMS), 73.5% included cases who received medical care and 53.1% defined outcomes as survival or death. A total of 78 different factors were studied; the most commonly studied group of factors described victim demographics, included in 42 studies (85.7%), followed by resuscitation factors, included in 30 studies (61.2%). Few studies described rescue (6.1%). The most frequent statistically significant single predictors of outcome known at the scene were submersion duration (evaluated in 19, predictor in 14) and age (evaluated in 31, predictor in 16). Only 38.7% of studies employed multivariable methods. Gaps to be addressed in drowning outcomes research include data from low- and middle-income countries, standardized definition of factors to allow evaluation across studies, inclusive study populations that can be generalized beyond those receiving medical care, study rescue and resuscitation factors, use of more meaningful outcomes (survival with good neurologic status) and advanced analyses to identify which factors are true predictors versus confounding variables.

Two cases study of fouling colonization patterns in the Mediterranean Sea in the perspective of integrated aquaculture systems

Fouling assemblage colonizing fish-farms is considered mostly to produce negative impacts causing financial loss. By contrast, large evidences emerged on the bioremediation role by biofouling associated to aquaculture facilities, even if the fouling assemblages thriving in the water column was poorly investigated. The aim of the present work was to investigate the macrofouling assemblages over one year of immersion, in order to single out the fouling species, which play the most remarkable role for the bioremediation of the marine areas affected by aquaculture activities. With this in mind, we studied the fouling community dynamics in two Mediterranean maricultural facilities, respectively in the Mar Grande of Taranto (Ionian Sea) and in the Gulf of Gaeta (Tyrrhenian Sea), using the same experimental design and time frame. Two experiments were carried out using artificial panels anchored to two finfish cages. The one-year old fouling communities in the two sites were compared at four seasons of immersion, four submersion durations and three depths, both communities from structural and functional points of view. Notwithstanding the quite similar species composition of fouling of the two sites, the biofouling showed the highest biodiversity in the Mar Grande of Taranto. In the Gulf of Gaeta mussels, Mytilus galloprovincialis, dominated at all the times and depths, whilst in the Mar Grande of Taranto they were especially abundant at the surface with the deepest panels being largely colonized by polychaete sabellids. The co-occurrence of the filter-feeders Mytilus-sabellids recorded in the Gulf of Taranto also highlighted the highest filtration capability. Our results suggest two different fouling assemblages as candidates for bioremediation in integrated multitrophic aquaculture facilities: both a monospecific system dominated by mussels and a multi-specific system with sabellids and mussels as most abundant filter-feeders.

Negative Feedback by Vegetation on Soil Organic Matter Decomposition in a Coastal Wetland

There has been much debate about the external drivers that affect the decomposition of soil organic matter (SOM). Particularly, the feedback mechanisms between SOM and mineral weathering are poorly understood. We used the cotton strip assay combined with measurements of water table, pore water salinity, and soil properties along a landscape-scale gradient to study these mechanisms. The results revealed that cotton tensile strength loss (CTSL) rates ranged from 2.0% day−1 to 4.6% day−1 and varied significantly among sites and depths. A multiple regression model revealed that the corelation between the CTSL and submersion duration (SD) was positive when the chemical index of alteration (CIA) was ~65% and negative over most of the range of SD when the CIA was ~45%. The results suggest that the hydrological conditions induced by tidal effects endanger the stocks of carbon sequestered in coastal wetland soils. However, sites with CTSL rates as high as 4.0–5.0% day−1 tended to gain more nutrients than sites with lower CTSL rates. The fixation of atmospheric CO2 via plant growth may therefore be stimulated in coastal wetland soils by the recycling of mineral nutrients via enhanced weathering. The result is a negative feedback of the ecotone on SOM decomposition.

Seed Longevity of Spotted Spurge and Wild Poinsettia Under Diverse Environmental Conditions

ABSTRACT: Seed longevity under different environmental conditions is considered as one of the most important factors in the spread and persistence of an exotic species. The Experiments were conducted to determine seed persistence in soil, effects of submergence in water, flooding of the soil, and high temperatures on germination and viability of spotted spurge (Chamaesyce maculata) and wild poinsettia (Euphorbia heterophylla) as two exotic species in different regions of Golestan province. Spotted spurge seeds buried at depth of 10 cm maintained their viability above 95% after a year, while wild poinsettia seeds were destroyed completely after exhuming the soil. Seeds of both species were unable to germinate under submergence, but 92% of the spotted spurge seeds remained viable under this condition for 14 d. No germination was observed after 9 weeks submersion. Submersion duration drastically affected seed germination of wild poinsettia, so that no germination occurred after 6 d submersion. Twelve days after flooding, spotted spurge emergence decreased by 57% compared to the control. Ten percentage of wild poinsettia seedlings emerged when flooding was kept up to 12 d after sowing, while control had 96% emergence. Germination of spotted spurge seeds subjected to 140 oC for 5 min was 5%. Viability of wild poinsettia seed was completely lost at 120 and 140 C for 5 min. These results suggest that spotted spurge is capable of forming persistent seedbank. Seeds of spotted spurge were partially tolerant to submersion in water, but wild poinsettia seed are susceptible to submergence. The burning of crop residue could also prevent augmenting the soil seed bank of both species.

Approximate Weight of 1:1000 Topical Epinephrine on Wrung-Out Epinephrine-Soaked Pledgets.

Topical 1:1000 epinephrine solution is commonly applied intranasally with cottonoid pledgets in endoscopic sinonasal surgery for local vasoconstriction and hemostasis. Pledgets are typically submerged in epinephrine solution and applied without measurement. Hemodynamic complications have been reported when pledgets have been saturated and not wrung out. The amount of epinephrine absorbed per pledget has not been studied methodically. The purpose of this study was to determine the amount of topical 1:1000 epinephrine remaining on a cottonoid pledget after wringing out the pledget, to simulate intraoperative application. Cohort study. Tertiary care center. Sixty 0.5-in × 3-in cottonoid pledgets were submerged in canisters filled with 1:1000 epinephrine solution (1 mg/mL). Weights of the epinephrine-filled canisters were measured before submerging the pledgets and then after removing and wringing out the pledgets. Measurements were recorded for each pledget after being submerged for 0, 1, and 5 minutes and then wrung out. Mean weights were calculated and compared between the submersion durations. The mean overall weight of epinephrine on a wrung-out pledget was 0.931 mg. Mean weights of epinephrine absorbed onto wrung-out pledgets after submersion for 0, 1, and 5 minutes were 0.914, 0.913, and 0.967 mg, respectively. There were no significant differences in weights based on submersion duration (P = .296). Approximately 1 mg of epinephrine was absorbed onto 0.5-in × 3-in cottonoid pledgets when pledgets were wrung out after being submerged in 1:1000 epinephrine, whether being removed from solution immediately or after up to 5 minutes.

Better Groundwork Can Avoid Troubled Waters: A Developing Country Perspective on Drowning.

Drowning is a leading cause of unintentional injury-related death in low- and middle-income countries (LMICs). This study was undertaken to know the epidemiology, intensive care needs and predictors of outcome of children with drowning. Records of children below 12 years admitted with drowning to the emergency room and/or paediatric intensive care unit (PICU) of a tertiary care hospital in North India were retrospectively analysed. 'Favourable outcome' was defined as normal neurological status at discharge (normal cognition and no motor deficits) and 'unfavourable outcome' as death or abnormal neurological status at discharge. Multivariable analysis was done for predictors of unfavourable outcome. Twenty-seven children were analyzed, 14 (51.8%) were boys. Median (IQR) age was 18 months (12-30). The median (IQR) duration of submersion was 4 min (3-9). Six children (22.2%) presented in pulseless arrest, and 7 (43.7%) had both hypoxaemia (saturation <94% on room air) and encephalopathy (GCS <13) at admission. Ten children (37%) were transferred to PICU; principal indications being hypoxic ischaemic encephalopathy (HIE) (n = 6) and ventilation (n = 4). One child died, four survived with sequalae. Predictors of unfavourable outcome on univariable analysis were hypoxaemia, or pulseless arrest at admission, HIE and need for mechanical ventilation; none of these could predict outcome on multivariable analysis. Hypoxaemia or pulseless arrest at admission, HIE and need for ventilation predict unfavourable outcome. Appropriate on-site resuscitation and early stabilization may improve outcome in children with drowning in LMIC.

A Review of Nonfatal Drowning in the Pediatric-Age Group: A 10-Year Experience at a University Hospital in Saudi Arabia.

The aim of this study was to evaluate the nonfatal drowning experience, risk factors, intrahospital assessment and postincidental outcomes for children admitted to King Fahd Hospital of the University, AlKhobar, Saudi Arabia, over a 10-year period. Children up to the age of 14 years who were admitted with the diagnosis of nonfatal drowning from July 2005 to June 2015 were included. Data regarding demographics, timing, season and location of drowning, presence of an assigned lifeguard, duration of submersion and transport to hospital, cardiopulmonary resuscitation, initial Glasgow Coma Scale, temperature, pH, blood sugar level, total hospital stay, and discharge status were extrapolated, and their effects on the patient's outcome analyzed. Patients' outcomes were classified into either full recovery, moderate to severe neurological damage, or brain death. Fifty-one subjects were included in the study; 66.7% were males, 57% were younger than 6 years, and 80% were Saudi citizens. Of the total cases, 94% recovered fully, and 6% were diagnosed as having brain death or discharged from the intensive care unit with severe neurological injury. Submersion time of more than 5 minutes, Glasgow Coma Scale of 4 or less, pH of less than 7.1, temperature of 35°C or less, and blood sugar of 180 mg/dL or greater were found to correlate with bad outcomes with great statistical significance. The findings of this study were in line with results of most of the international and local studies on the subject. Significant defects have been concluded in prehospital medical care and cardiopulmonary resuscitation. Adequate swimming safety regulations, assignments of lifeguards, and parental education should be taken into consideration by media and involved authorities.

Bystander-initiated conventional vs compression-only cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest due to drowning

BackgroundGreat emphasis has been placed on rescue breathing in out-of-hospital cardiac arrest (OHCA) due to drowning. However, there is no evidence about the effect of rescue breathing on neurologically favorable survival after OHCA due to drowning. The aim of this study is to examine the effect of bystander-initiated conventional (with rescue breathing) versus compression-only (without rescue breathing) cardiopulmonary resuscitation (CPR) in OHCA due to drowning. MethodsThis nationwide population-based observational study using prospectively collected government-led registry data included patients with OHCA due to drowning who were transported to an emergency hospital in Japan between 2013 and 2016. The primary outcome was one-month neurologically favorable survival. ResultsThe full cohort (n = 5121) comprised 2486 (48.5%) male patients, and the mean age was 72.4 years (standard deviation, 21.6). Of these, 968 (18.9%) received conventional CPR, and 4153 (81.1%) received compression-only CPR. 928 patients receiving conventional CPR were propensity-matched with 928 patients receiving compression-only CPR. In the propensity score-matched cohort, one-month neurologically favorable survival was not significantly different between the two groups (7.5% in the conventional CPR group vs. 6.6% in the compression-only CPR group; risk ratio, 1.15; 95% confidence interval, 0.82–1.60; P = 0.4147). This association was consistent across a variety of subgroup analyses. ConclusionsAmong patients with OHCA due to drowning, there were no differences in one-month neurologically favorable survival between bystander-initiated conventional and compression-only CPR groups, although several important data (e.g., water temperature, submersion duration, or body of water) could not be addressed. Further study is warranted to confirm our findings.