Background
USFD parameters | Core/Supplemental | |
---|---|---|
Victim Information | Victim identifier | Core |
Gender | Core | |
Age | Core | |
Race or Ethnic category
|
Supplemental
| |
Date and time of day of incident | Core | |
Residence
|
Supplemental
| |
Precipitating event | Core | |
Preexisting illness
|
Supplemental
| |
Scene information | Witnessed | Core |
Body of water | Core | |
Water/liquid type
|
Supplemental
| |
Approximate water temperature
|
Supplemental
| |
Time of submersion
|
Supplemental
| |
Time of removal of victim from water
|
Supplemental
| |
Unconscious when removed from water | Core | |
Cyanosis
|
Supplemental
| |
Resuscitation before EMS arrived | Core | |
Method of CPR
|
Supplemental
| |
EMS called | Core | |
EMS vehicle dispatched
|
Supplemental
| |
Time of first EMS assessment
|
Supplemental
| |
Initial vital signs | Core | |
Oxygen saturation, temperature, blood pressure, pupillary reaction
|
Supplemental
| |
Time of first EMS resuscitation attempt | Core | |
Neurological status | Core | |
Emergency Department Evaluation and Treatment | Vital signs | Core |
Oxygen hemoglobin saturation | Core | |
Arterial blood gas analysis, if unconscious or SaO2 < 95% on room air | Core | |
Initial neurological status | Core | |
Pupillary reaction
|
Supplemental
| |
Airway and ventilation requirements | Core | |
Toxicology testing
|
Supplemental
| |
Hospital Course | Airway and ventilation requirements | Core |
Serial neurological function (admission, 6 h, 24 h, 72 h, discharge)
|
Supplemental
| |
Complicating illnesses
|
Supplemental
| |
Disposition | Alive or dead | Core |
Date of hospital discharge | Core | |
Neurological outcome at hospital discharge | Core | |
Quality of life
|
Supplemental
| |
Cause of death
|
Supplemental
| |
Other injuries and morbidities
|
Supplemental
|
Methods
Results
Study | Year of publication | Country | Study description | Victims | Category | USFD parameters | |
---|---|---|---|---|---|---|---|
(N) | Adults/Children | Core (%) | Supplemental (%) | ||||
Eich et al. [3] | 2007 | Germany | Retrospective chart review on out of hospital cardiac arrest (OHCA) due to drowning and sustained resuscitation with CPB | 12 | Children | 19 (86.4%) | 11 (57.9%) |
Grmec et al. [4] | 2009 | Slovenia | Retrospective chart review comparing the data of 528 primary cardiac arrest victims with 32 drowning victims | 32 | Adults | 8 (36.4%) | 3 (15.8%) |
Youn et al. [5] | 2009 | South Korea | Prospective study on OHCA due to drowning | 131 | Adults and Children | 19 (86.4%) | 8 (42.1%) |
Venema et al. [6] | 2010 | Netherlands | Retrospective study on bystander rescue and resuscitation | 343 | Adults and Children | 14 (63.6%) | 12 (63.2%) |
Choi et al. [7] | 2012 | South Korea | Retrospective chart review on OHCA due to drowning and treatment with therapeutic hypothermia | 20 | Adults | 15 (68.2%) | 8 (42.1%) |
Vähätalo et al. [8] | 2014 | Finland | Retrospective chart review of drowning children under 16 years of age who were hospitalized or died due to drowning | 58 | Children | 12 (54.5%) | 4 (21.1%) |
Joanknegt et al. [9] | 2015 | South Africa | Retrospective chart review of drowning victims to inform prevention strategies | 75 | Children | 13 (59.1%) | 5 (26.3%) |
Kieboom et al. [10] | 2015 | Netherlands | Retrospective chart review on hypothermic drowning victims with OHCA | 160 | Children | 13 (59.1%) | 5 (26.3%) |
Hunsucker et al. [11] | 2011 | USA | Retrospective chart review on rescue reports of drowning victims with loss of spontaneous respiration in a waterpark environment | 32 | Adults and Children | 6 (27.3%) | 2 (10.5%) |
Allan et al. [12] | 2010 | USA | retrospective chart review on US military drowning victims in in Iraq | 8 | Adults | 10 (45.5%) | 11 (57.9%) |
Ma et al. [13] | 2010 | China | matched case control study on non-fatal drowning | 325 | Children | 7 (31.8%) | 1 (5.3%) |
Wanscher et al. [14] | 2012 | Denmark | Retrospective review of a boating accident involving drowning victims and non-drowning victims with accidental hypothermia. | 15 | Adults and Children | 18 (81.1%) | 10 (52.6%) |
Orlowski et al. [15] | 2012 | USA | Retrospective chart review on drowning occurring during a visit to relatives or friends | 100 | Children | 8 (36.4%) | 3 (15.8%) |
Champigneulle et al. [16] | 2015 | France | Retrospective chart review on drowning victims with OHCA treated with extracorporeal life support | 43 | Adults and Children | 17 (77.3%) | 9 (47.4%) |
USFD parameters
(Core/Supplemental)
| Total use (n) | Overall description | Significant relation with outcome |
---|---|---|---|
Victim Information | |||
Age (Core) | 14 | One publication shows that survivors are significantly younger than non-survivors (38.9 ± 12.6 versus 56.6 ± 18.7; p = 0.03) [4]. | |
Date and time of day of incident (Core) | 6/9 | Six publications describe the time of day [3, 5, 6, 8, 13, 14] and nine publications describe the season the drowning occurred in [3, 5‐8, 10, 11, 13, 14]. Four publications describe that 39–100% of drownings occur during the daytime [3, 5, 8, 13] One publication reports that 67% of drownings occur between 12 AM and 8 PM and 33% of drownings from 9 PM to 11 AM [6]. Forty-seven to One hundred percent of drowings are reported to occur between springtime and the end of the summer [3, 5‐8, 10, 11, 13]. | One publication shows that outcome after drowning is significantly better in winter compared to other seasons: odds ratio 4.6 (1.4–15.1), p = 0.013 [10]. |
Scene information | |||
Witnessed (Core) | 10 | One publication shows that survivors are more likely to have had a witnessed drowning event than non-survivors (76 versus 61%; p = 0.036) [5]. | |
Approximate water temperature (Supplemental) | 6 | In one publication a median water temperature for survivors of 20.4 (Interquartile range 13.7, 27.0) and 20.00 C (interquartile range 8.6, 23.8) was reported (p = 0.184) [8]. In three publications a large range (0–280 C) was reported [3, 10, 16]. In one study the water temperature was 20 C for all victims [14]. In one publication the water temperature was described as warm (14%), cold (84%, or ice-cold (3%) [6]. | In one publication the water temperature was lower for 24 h survivors among victims treated with ECLS (p = 0.04) [16]. |
Time of submersion (Supplemental) | 10 | ||
Resuscitation before EMS arrived (Core) | 10 | Resuscitation attempts before the arrival of EMS varies between 24 and 93% [3‐6, 8‐11]. In one publication this parameter was described in 19% of the cases, of which 79% were resuscitated before EMS arrival [15]. In one publication BLS was immediately started after removal from the water in 100% of the victims by police officers or firefighters before ALS providers arrived [16]. | |
Oxygen saturation, temperature, blood pressure, pupillary reaction (Supplemental) | 6 | In one publication unresponsive and dilated pupils is significantly related with bad outcome (p < 0.001) [9]. In one publication the first prehospital core temperature was lower in the 24 h survivors among patients treated with ECLS (p = 0.07) [16]. In this same publication the association between a first prehospital core temperature of ≤260 C and serum potassium level between 4.2 and 6.0 identified 24 h survivors among patients treated with ECLS with 100% sensitivity (95% CI: 28–100%) and specificity (95% CI: 71–100%). | |
Time of first EMS resuscitation attempt (Core) | 3 | In another publication this parameter is included, but the information is not available in any victims [6]. | The time of first EMS resuscitation is found to be significantly associated with outcome in one publication: 11.2 ± 5.6 min in survivors versus 21.4 ± 12.8 min in non-survivors; p = < 0.001 [5]. |
Emergency Department Evaluation and Treatment | |||
Vital signs (Core) | 8 | In one publication resuscitation at arrival in the ED is negatively associated with outcome (p < 0.001, OR 0.03, 95% CI 0.01–0.13) [9]. In the same publication hypothermia is significantly related to bad outcome (p < 0.001, OR 18.00, 95% CI 3.35–96.74). In one publication 24 h survivors among patients treated with ECLS had a significantly lower in hospital initial core temperature (p = 0.004) [16]. | |
Arterial blood gas analysis, if unconscious or SaO2 < 95% on room air (Core) | 8 | The more severe the acidosis, the worse outcome is (p < 0.001–0.014) [8‐10]. In one publication an initially lower pH relates to hospital mortality (p = 0.008) [7]. Drowning cardiac arrest victims have a higher initial pCO2 compared to non-drowning victims in cardiac arrest (p < 0.001). Endtidal CO2 after 1 min of CPR (p 0.02) and the final endtidal CO2 (p < 0.001) were independent factors for survival [10]. Less negative base excess is related to better outcome. (p < 0.001–0.001) [8, 10]. | |
Initial neurological status (Core) | 8 | The GCS is 3 at the ED in all patients in three publications (in only one patient in one of these studies a palpable pulse was reported) [3, 5, 7]. In one publication the median Glasgow Coma Score (GCS) ranged between 11.5 in survivors and 3 in non-survivors [8]. In one publication the GCS was described as < 5 (41% good outcome, 18% neurologic sequelae, 41% death) or ≥ 5 (98% good outcome, 2% death) [9]. In one publication the median GCS was 3 [10]. In one publication the GCS ranged from 3 to 15 [14]. One study described that none of the victims had clinical signs of life [16]. | |
Pupillary reaction (Supplemental) | 4 | Unreactive dilated pupils in the ED are significantly related to bad outcome in one publication (p < 0.001; OR 0.01; 95% CI 0.04–0.23) [9]. | |
Airway and ventilation requirements (Core) | 7 | Intubation at the ED (p = 0.002) is significantly related to bad outcome in one publication [9]. | |
Hospital Course | |||
Serial neurological function (admission, 6 h, 24 h, 72 h, discharge) (Supplemental) | 3 | In one publication myoclonic or seizure activity (including treatment with medications), loss of pupillary response, absent motor response to pain, somatosensory evoked potentials (SSEPs), and the use of brain imaging are described [7]. One publication only describes the use of a CT scan [12]. One publication describes the use of electroencephalographic recordings, SSEPs, magnetic resonance imaging and the use of biomarkers (neuron specific enolase and protein S100B) [14]. | Neurological function testing, somatosensory evoked potentials (SSEPs), brain imaging (computed tomography or diffusion-weighted imaging) and neurological examination of motor response to motor response to pain after 3 days, are significantly related to bad outcome in one publication [7]. |
USFD parameters (Core/Supplemental) | Total use (n) | Overall conclusions |
---|---|---|
Victim Information | ||
Victim identifier (Core) | 6 | Not related to a conclusion |
Gender (Core) | 14 | |
Precipitating event (Core) | 10 | |
Pre-existing illness (Supplemental) | 5 | |
Scene information | ||
Body of water (Core) | 13 | Drowning occurs mostly (66–100%) in natural bodies of water such as rivers, lakes and canals in eight publications [3, 5‐8, 10, 12‐14, 16]. Two publications report that drowning occur predominantly (52 and 95%) in private or public pools [9, 15]. Another publication has only included drowning in swimming pools [11]. |
Water/liquid type (Supplemental) | 11 | Seven publications predominantly (84–100%) report fresh water drownings [3, 5‐8, 10, 16]. In one publication drowning in roadside ditches, canals and retention ponds are reported as the predominant water sources, however salinity was not determined [12]. In one publication all drownings occurred in salt water [14]. In the two publications where most drownings occurred in pools, the salinity of these pools was not specified [9, 15]. |
Unconscious when removed from water (Core) | 8 | |
Method of CPR (Supplemental) | 6 | One publication only reported that the victims were resuscitated according to guidelines [16]. Five publications described in more detail how resuscitation was performed, based on which it seems that international guidelines were followed [4‐6, 11, 14]. One of these publications reported that in 10% resuscitation was not performed according to guidelines (tapping on back, rubbing abdomen, pressing water out of lungs etc.) [6]. Another one of these publications described the use of abdominal trusts in and outside the water [11]. |
EMS called (Core) | 11 | Calling the EMS is directly or indirectly reported in 11 publications but as such provides no relevant information. |
EMS vehicle dispatched (Supplemental) | 10 | Dispatch of the EMS is directly or indirectly reported in ten publications but as such provides no relevant information. |
Initial vital signs (Core) | 5 | Two publications directly or indirectly reported that all victims were in cardiac arrest [3, 16]. One publication reported that all victims had a Glasgow Coma Scale of 3 [5]. One publication reported that 53% of the victims were in cardiac arrest [14]. One publication described that the information was available in 0.3% of the victims but made no further specifications [6]. |
Neurological status (Core) | 5 | Two publications reported that all victims had a Glasgow Coma Scale of 3 [3, 5]. One of these publications also reported fixed dilated pupils for all patients [3]. One publication reported that 16% of the victims were unconscious and 84% were conscious [6]. One publication reported that four patients (50%) were comatose of which two had fixed dilated pupils with diffuse flaccid paralysis. This same publication also reported a mean initial Glasgow Coma Scale of 10.4 [12]. In one publication this information was indirectly available because all were in cardiac arrest [16]. |
Hospital Course | ||
Airway and ventilation requirements (Core) | 7 | |
Complicating illnesses (Supplemental) | 6 | Six publications report complicating illnesses such as pneumonia, acute respiratory distress syndrome, pancreatitis, rhabdomyolysis, disseminated intravascular coagulation acute renal failure, multiple organ failure and septic shock [3, 5, 7, 9, 12, 16]. In one of these publications extubation stridor, minor neurologic deficits and corneal ulceration are reported which all are resolved at the time of discharge [9]. |
Disposition | ||
Alive or dead (Core) | 14 | |
Neurological outcome at hospital discharge (Core) | 10 | In four publications 7–20% had a (Paediatric) Cerebral Performance Scale/Category (P)CPC score of one to two [3, 5, 7, 8]. In one publication 85% of the patients had a CPC score of one to two [4]. In one publication 84% of the patients do not have any neurological complications, while 5.3% have irreversible neurological sequellae [9]. In one publication 11% of the patients have a (P)CPC score of three or less 1 year after the drowning incident [10]. In one publication hypoxic encephalopathy is reported in one victim (13%) [12]. One publication described a median Functional Independence Measure of 115 (range 51–121) and a median extended Glasgow Coma Scale score of 4 (range 3–7) after 6 months [14]. In one publication two victims (5%) survived to hospital discharge of which one had a CPC score (at discharge and at 6 months later) of one and one had a CPC score of three [16]. |
Cause of death (Supplemental) | 5 |