Case reportRecovery of a hypothermic drowned child after resuscitation with cardiopulmonary bypass followed by prolonged extracorporeal membrane oxygenation☆
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
References (29)
- et al.
Cold water submersion and cardiac arrest in treatment of severe hypothermia with cardio-pulmonary bypass
Resuscitation
(2002) - et al.
Resuscitation in near drowning with extracorporeal membrane oxygenation
Ann Thorac Surg
(2001) - et al.
Immersion, near-drowning and drowning
Br J Anaesth
(1997) - et al.
ILCOR advisory statement—recommended guidelines for uniform reporting of data from drowning: the “Utstein style”
Resuscitation
(2003) - et al.
Successful resuscitation of a patient with severe accidental hypothermia and prolonged cardiocirculatory arrest using cardiopulmonary bypass
J Cardiothorac Vasc Anesth
(1997) - et al.
Does water temperature affect outcome of nearly drowned children
Resuscitation
(1997) Outcome from severe accidental hypothermia in Southern Finland—a 10-year review
Resuscitation
(2003)- et al.
Impact of age, submersion time and water temperature on outcome in near-drowning
Resuscitation
(2002) Drowning, near-drowning, and ice-water submersions
Pediatr Clin N Am
(1987)- et al.
Resuscitation from accidental hypothermia of 13.7 °C with circulatory arrest
Lancet
(2000)
Prognostic markers in patients with severe accidental hypothermia and cardiocirculatory arrest
Resuscitation
Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care—an international consensus on science
Resuscitation
Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming
N Engl J Med
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The use of drones and a machine-learning model for recognition of simulated drowning victims—A feasibility study
2020, ResuscitationCitation Excerpt :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
Management of accidental hypothermia: A narrative review
2019, Medicina IntensivaExtracorporeal life support for victims of drowning
2016, ResuscitationCitation Excerpt :Initial resuscitation efforts may involve airway management and respiratory support in spontaneously breathing victims or cardiopulmonary resuscitation for victims who experience cardiac arrest. The use of ECLS to support drowning victims with life-threatening respiratory or cardiopulmonary failure has been described in a few case reports and small case series.6–8,13 The largest series to date describes 20 patients who received ECLS for refractory cardiac arrest after drowning over an 11-year period.9
Hypothermia with extracorporeal membrane oxygenation for sudden cardiac death and submersion
2010, American Journal of Emergency Medicine
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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.