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Rewarming Young Children After Drowning-Associated Hypothermia and Out-of-Hospital Cardiac Arrest: Analysis Using the

Maya Caroline Andre1, Raphael Nicolas Vuille-Dit-Bille2, Andreas Berset3

  • 1Division of Respiratory and Critical Care Medicine, University of Basel Children´s Hospital, Basel, Switzerland.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|May 3, 2023
PubMed

Insights

Conventional rewarming is more effective than extracorporeal membrane oxygenation (ECMO) for pediatric drowning patients with hypothermia and cardiac arrest. ECMO was associated with lower survival rates and less favorable outcomes in this patient population.

Area of Science:

  • Pediatric critical care medicine
  • Cardiopulmonary resuscitation
  • Hypothermia management

Background:

  • Extracorporeal membrane oxygenation (ECMO) is recommended for adults with drowning-associated hypothermia and out-of-hospital cardiac arrest (OHCA).
  • Optimal rewarming procedures for pediatric drowning patients with severe hypothermia and cardiac arrest remain unclear.

Observation:

  • A case of a 2-year-old girl with severe hypothermia (23°C) and prolonged cardiac arrest (58 minutes) due to drowning prompted this analysis.
  • A review of 57 pediatric cases (≤6 years, temperature ≤28°C) compared conventional intensive care rewarming with ECMO.
  • Patients undergoing ECMO had longer submersion times and more severe initial metabolic derangements.

Findings:

  • Conventional rewarming resulted in a 92% survival rate, with 91% having favorable outcomes.
  • ECMO was associated with a 41% survival rate, with 77% of survivors having favorable outcomes.
  • No correlation was found between rewarming rate and patient outcome.

Implications:

  • Conventional rewarming should be the initial approach for pediatric drowning patients with OHCA and severe hypothermia.
  • Consideration for withdrawal of intensive care may be prudent if return of spontaneous circulation is not achieved by 34°C core temperature.
  • Further research using an international registry is recommended to refine treatment guidelines for this vulnerable population.
Abstract

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