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Outcome following cardiopulmonary resuscitation in severe pediatric near-drowning
Insights
Severe pediatric near-drowning victims requiring cardiopulmonary resuscitation have a 50% mortality rate. Aggressive resuscitation is warranted, but cerebral measures need further evaluation for improved outcomes.
Area of Science:
- Pediatric critical care medicine
- Emergency medicine
- Neurology
Background:
- Near-drowning incidents in children can lead to severe hypoxic-ischemic brain injury.
- Early and aggressive resuscitation is crucial for survival in pediatric near-drowning cases.
- Glasgow Coma Scale (GCS) is a key indicator of neurologic status upon admission.
Purpose of the Study:
- To evaluate the outcomes of pediatric patients admitted to the ICU after severe near-drowning.
- To assess the effectiveness of resuscitation and intracranial pressure management.
- To identify predictors of survival and neurologic outcome.
Main Methods:
- Retrospective analysis of 66 pediatric near-drowning patients admitted to ICU.
- Patients required cardiopulmonary resuscitation with initial GCS of 3.
- Neurologic status (GCS) and intracranial pressure (ICP) were monitored and managed.
Main Results:
- Overall mortality was 50% (33 deaths).
- 24% had intact survival, and 26% had vegetative survival.
- No patient with an initial GCS of 3 (flaccid) survived neurologically intact; 26/37 died, 11/37 had severe brain damage.
Conclusions:
- Aggressive emergency room resuscitation for severe pediatric near-drowning is justified.
- Cerebral resuscitative measures require critical prospective evaluation.
- Neurologic outcome is strongly correlated with initial GCS score.
Abstract:
Between April 1979 and September 1984, 66 children were admitted to the intensive care unit (ICU) at Childrens Hospital of Los Angeles after a severe near-drowning episode. Each patient required full cardiopulmonary resuscitation and had an initial Glasgow coma score (GCS) of 3 in a referring emergency room. Patients were reclassified according to results of a neurologic examination (GCS) on arrival in the ICU. The overall results showed 16 patients (24%) with apparently intact survival, 17 patients (26%) with vegetative survival, and 33 deaths (50%). No patient who arrived at the ICU with a GCS of 3 (flaccid) survived neurologically intact. Out of 37 such patients arriving in flaccid coma, 26 patients died and 11 patients suffered severe brain damage. The majority of patients with GCS of less than 6 underwent intracranial pressure (ICP) monitoring and aggressive therapy directed to control ICP. Despite adequate control of ICP and maintenance of cerebral perfusion pressure, 12 monitored patients survived in a vegetative neurologic state. The results justify aggressive emergency room resuscitation of severe pediatric near-drowning victims but suggest that cerebral resuscitative measures must be subjected to critical prospective evaluation.