Elsevier

Resuscitation

Volume 80, Issue 7, July 2009, Pages 778-783
Resuscitation

Clinical paper
Out-of-hospital cardiac arrest due to drowning: An Utstein Style report of 10 years of experience from St. Mary's Hospital

https://doi.org/10.1016/j.resuscitation.2009.04.007Get rights and content

Abstract

Background

Drowning is a unique form of cardiac arrest and is often preventable. “Utstein Style for Drowning” was published in 2003 by the International Liaison Committee on Resuscitation (ILCOR) to improve the knowledge-base, to provide epidemiological stratification, to recommend appropriate treatments and to ultimately save lives. We report on the largest single-center study of the Utstein Style resuscitation for drowning.

Methods

All patients with out-of-hospital cardiac arrest (OHCA) due to drowning admitted to St. Mary's Hospital between 1998 and 2007 were included. Utstein Style variables and other time intervals not included in the Utstein Style guidelines were evaluated for their ability to predict survival. The primary end point of this study was survival to discharge.

Results

We enrolled 131 patients with OHCA due to drowning; 21 patients (16.03%) had survival to discharge and 9 patients (6.87%) were discharged with a good neurologic outcome, i.e., cerebral performance categories (CPC) of 1 or 2. For the Utstein Style variables witnessed, the duration of submersion and the time of first emergency medical systems (EMS) resuscitation attempt influenced survival. For other time intervals, the transportation time (i.e., time interval from witnessing of the drowning to EMS arrival at the hospital, or if events were not witnessed, the time interval from calling the EMS to EMS arrival at the hospital), the duration of advanced cardiovascular life support (ACLS) and the duration of total arrest time were associated with survival.

Conclusions

Our report is the largest single-center study of OHCA due to drowning reported according to the guidelines of the Utstein Style. Being witnessed, having a short duration of submersion, having early resuscitation by EMS, and rapid transportation are important for survival after drowning.

Introduction

Drowning accounts for more than one half million deaths annually worldwide.1 And drowning is 7% of all injury-related disability-adjusted life years (DALYs) worldwide.2 In Korea, the average annual incidence of drowning-related injury is almost 2500 and that of drowning-related annual death is almost 1950.3 In some cases, drowning events can be preventable.

There have been many studies of drowning, but there is a general lack of consistency in the definition of drowning and clinical parameters.4 Few studies have evaluated the results of attempted resuscitation from drowning, beginning from the scene of drowning through hospital admission, hospital discharge, and long-term follow up. Most studies of drowning outcomes have been hospital-based, but for some aspects, pre-hospital incident-related events are key factors.5, 6, 7 These issues were discussed in an International Liaison Committee on Resuscitation (ILCOR) and published in October 2003, referred as the “Utstein Style for Drowning”.8

The aim of this study is to describe the outcomes of drowned patients in all age groups who needed resuscitation at the scene. Initially, the outcomes were analyzed by Utstein Style variables. In addition, other time intervals that did not include Utstein Style variables were used to predict survival outcomes.

Section snippets

Patients and settings

All patients with out-of-hospital cardiac arrest (OHCA) due to drowning admitted to St. Mary's Hospital between 1998 and 2007 were included with the exception of patients who had obviously been dead for a long time.

St. Mary's hospital is a tertiary educational hospital that is close to the Han River, in Seoul, Korea. St. Mary's hospital serves a regional population of about 1,500,000. Annually, more than 30 patients are brought to our hospital due to drowning in the Han River irrespective of

Victim information

A total of 131 patients with OHCA due to drowning were enrolled. The mean age was 40.3 ± 18.0 years (range, 3–87 years), 128 patients were adults, and 74 patients (56.5%) were male. Fifty-one patients drowned during the daytime and the remainder during night. Thirty-seven cases (28.2%) occurred in the spring, 51 cases (38.9%) in the summer, 25 cases (19.1%) in the fall, and 18 cases (13.8%) in the winter. The precipitating event was unknown for most patients (103 patients, 78.6%). There were 18

Discussion

Although this was a retrospective study, to our knowledge, this study is the largest single-center study of OHCA due to drowning reported according to the Utstein Style. Before the “Utstein Style for Drowning” was published by ILCOR, there was a lack of standardized definitions and clinical characteristics of outcome measures. There has been one study that has reported drowning events according to the Utstein Style, but, it was the report of drowned children who underwent attempted

Limitations

There were some limitations in this study. First, there was missing information for the variables that were evaluated retrospectively and that occurred before hospital arrival. Second, some of the data that were collected in the pre-hospital phase were likely not accurate. Third, there were a small number of pediatric patients, so we were unable to evaluate the benefit of children compared with adults for survival outcomes.

Conclusions

This single-center study is, to our best knowledge, the largest Utstein Style report of OHCA due to drowning. The overall rate of survival to discharge for OHCA due to drowning was 16.0%. Numerous factors contributed to survival, but, the factors that were most strongly associated with survival to discharge were witnessed drowning event, short duration of submersion, early resuscitation by EMS, and rapid transportation. Although the event and time intervals occurring prior to hospital arrival

Conflict of interest

There are no financial or other relations that might pose a conflict of interests.

Acknowledgement

The statistical analyses performed in this article were advised by Catholic Medical Center Clinic Research Coordinating Center.

References (24)

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“A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.04.007”.

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