Drowning - when is it rescue vs. recovery?

Short Attention Span Summary

Summertime = water = drowning.  When is the time to pivot from rescue to recovery of the body?  This is a tragic question but is crucial for the safety of rescuers risking their own lives.  Submersion < 5 minutes is usually associated with favorable outcome.  But >25 minutes was universally fatal.  This can guide prehospital rescue/recovery efforts.



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Abstract

Resuscitation. 2016 May 3;104:63-75. doi: 10.1016/j.resuscitation.2016.04.006. [Epub ahead of print]

Predicting outcome of drowning at the scene: A systematic review and meta-analyses.

Quan L1, Bierens JJ2, Lis R3, Rowhani-Rahbar A4, Morley P5, Perkins GD6.

Author information:

1Department of Pediatrics, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA; Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98145, USA; Harborview Injury Prevention & Research Center, 401 Broadway, University of Washington, Seattle, WA 98122, USA. Electronic address: linda.quan@seattlechildrens.org.

2Research Group Emergency and Disaster Medicine, Vrije Universiteit Brussels, Pleinlaan 2, 1050 Elsene, Belgium.

3Department of Epidemiology, School of Public Health, 1959 NE Pacific St, Seattle, WA 98195, USA.

4Harborview Injury Prevention & Research Center, 401 Broadway, University of Washington, Seattle, WA 98122, USA; Department of Epidemiology, School of Public Health, 1959 NE Pacific St, Seattle, WA 98195, USA.

5Royal Melbourne Hospital Clinical School, University of Melbourne, Grattan Street, Parkville, Victoria 3050, Australia.

6Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.

 

Abstract

OBJECTIVE:

To identify factors available to rescuers at the scene of a drowning that predict favourable outcomes.

DESIGN:

Systematic review and meta-analysis.

DATA SOURCES:

PubMed, Embase and Cochrane Library were searched (1979-2015) without restrictions on age, language or location and references lists of included articles.

STUDY SELECTION:

Cohort and case-control studies reporting submersion duration, age, water temperature, salinity, emergency services response time and survival and/or neurological outcomes were eligible. Two reviewers independently screened articles for inclusion, extracted data, and assessed quality using GRADE. Variables for all factors, including time and temperature intervals, were categorized using those used in the articles. Random effects meta-analyses, study heterogeneity and publication bias were evaluated.

RESULTS:

Twenty-four cohort studies met the inclusion criteria. The strongest predictor was submersion duration. Meta-analysis showed that favourable outcome was associated with shorter compared to longer submersion durations in all time cutoffs evaluated: ≤5-6min: risk ratio [RR]=2.90; (95% confidence interval [CI]: 1.73, 4.86); ≤10-11min: RR=5.11 (95% CI: 2.03, 12.82); ≤15-25min: RR=26.92 (95% CI: 5.06, 143.3). Favourable outcomes were seen with shorter EMS response times (RR=2.84 (95% CI: 1.08, 7.47)) and salt water versus fresh water 1.16 (95% CI: 1.08, 1.24). No difference in outcome was seen with victim's age, water temperatures, or witnessed versus unwitnessed drownings.

CONCLUSIONS:

Increasing submersion duration was associated with worse outcomes. Submersion durations <5min were associated with favourable outcomes, while those >25min were invariably fatal. This information may be useful to rescuers and EMS systems deciding when to perform a rescue versus a body recovery.

Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PMID: 27154004 [PubMed - as supplied by publisher]