Elsevier

Resuscitation

Volume 67, Issue 1, October 2005, Pages 145-148
Resuscitation

Case report
Recovery of a hypothermic drowned child after resuscitation with cardiopulmonary bypass followed by prolonged extracorporeal membrane oxygenation

https://doi.org/10.1016/j.resuscitation.2005.05.002Get rights and content

Abstract

Drowning is a leading cause of death in children worldwide. However, there is uncertainty about the initiation and the extent of adequate therapeutic interventions after drowning accidents. As prediction of outcome in drowned children remains difficult, initial maximum life support appears to be generally justified. We present the case of a 3-year-old drowned girl in refractory cardiorespiratory arrest who was resuscitated successfully with cardiopulmonary bypass (CPB) followed by extracorporeal membrane oxygenation (ECMO) for 4 days. After a prolonged period in a vegetative state eventually she made an almost complete neurological recovery. We do not have knowledge of any case of drowning reported with a favourable neurological outcome after such a prolonged period of ECMO.

Introduction

Drowning accounts for over 400,000 annual deaths worldwide and is a leading cause of mortality in children between 1 and 14 years of age [1]. While early basic life support (BLS) is a hallmark of successful resuscitation in general, rapid transport to a cardiac centre and the use of cardiopulmonary bypass (CPB) is widely advocated in sustained cardiorespiratory arrest after drowning [2], [3], [4], [5]. Comparatively little data exists on the role of extracorporeal membrane oxygenation (ECMO) in the resuscitation of drowned children [5], [6], [7].

Section snippets

Case report

In July 2002, a 3-year-old girl fell into a flooded river with a water temperature of 15 °C. She was found after more than 20 min of submersion, and basic life support (BLS) was started by the local Emergency Medical Services (EMS) team. On arrival of the emergency physician from our centre, the child was found to be deeply comatose with dilated and unresponsive pupils. She was apnoeic and pulseless with a slow idioventricular rhythm. Tracheal intubation and intravenous access were established.

Discussion

Drowning is worldwide a leading cause of mortality in children [1]. In the United States drowning is the third frequent cause of death in children under 14 and the most frequent in the age group between 1 and 2 [8]. In Germany each year about 100 children die from drowning [9]. The total number of drowning accidents is estimated to be 500–600 times higher [10].

It has been shown that non-comatose children with stabile vital signs on hospital admission have an almost 100% chance of an unimpaired

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      In water surface temperatures >15 degrees Celsius and after >15 min of submersion no survivors were reported over 15 years in Sweden.7 An extreme case of a 4-year old girl submerged in 15 degree C water for 20 min showing full recovery was reported from Germany.8 Traditional search and rescue using local search parties, fire departments freediving efforts and search from boats is however generally time consuming, demand a large number of rescuers and is a logistical challenge as vast areas may have to be searched.9

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    A Spanish translated version of the Abstract of this article appears as Appendix at 10.1016/j.resuscitation.2005.05.002.

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