Brain resuscitation in the drowning victim

Area of Science:

• Neurology
• Emergency Medicine
• Critical Care

Background:

• Drowning is a major cause of accidental death with survivors often experiencing severe neurological damage.
• Current clinical management for drowning lacks specificity regarding brain injury.
• Limited research exists on drowning-specific brain injury, necessitating evidence-based guidelines.

Purpose of the Study:

• To establish evidence-based consensus recommendations for the management and investigation of drowning victims.
• To address critical aspects of drowning care, including prehospital and intensive care, therapeutic hypothermia, neuroimaging, biomarkers, and neuroresuscitation.
• To guide clinical practice and future research in drowning neurocritical care.

Main Methods:

• Review of existing literature and expert consensus on drowning management.
• Inclusion of epidemiology, prehospital/ICU care, therapeutic hypothermia, neuroimaging, biomarkers, and pharmacology.
• Development of recommendations based on current evidence for brain-oriented care.

Main Results:

• Chest compressions with rescue breathing are recommended for drowning with cardiac arrest due to asphyxia.
• For comatose survivors, avoiding hypoxemia/hyperoxemia, treating hyperthermia, and considering induced hypothermia (32-34°C) are advised.
• Management includes treating blood pressure and glucose abnormalities, seizures, and utilizing serial neurological exams, imaging, and biomarkers for prognostication.

Conclusions:

• Immediate resuscitation should focus on cardiopulmonary support and maintaining physiological stability.
• Therapeutic hypothermia and avoiding secondary insults are crucial for neurological recovery.
• Transfer to specialized neurocritical care centers and ongoing quality improvement are essential for optimal patient outcomes.