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Effect of prehospital respiratory interventions on pediatric drowning outcomes
Oluwatosin Adenuga1, Elizabeth A Camp1, Rakesh D Mistry2
1Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, 6621 Fannin, Suite A 2210, Houston, TX, USA.
Insights
In pediatric drowning, endotracheal intubation showed no significant survival or neurological benefit over bag-valve mask for out-of-hospital cardiac arrest patients. Supplemental oxygen also did not impact outcomes in non-cardiac arrest cases.
Area of Science:
- Pediatric Emergency Medicine
- Resuscitation Science
- Drowning Research
Background:
- Effective respiratory management is crucial in pediatric drowning resuscitation.
- Prehospital airway adjuncts and oxygen administration are key interventions.
- This study investigates their impact on drowning outcomes.
Purpose of the Study:
- To evaluate the effect of prehospital airway adjuncts and supplemental oxygen on pediatric drowning outcomes.
- To compare endotracheal intubation versus bag-valve mask (BVM) in out-of-hospital cardiac arrest (OHCA) drowning.
- To assess supplemental oxygen use in non-OHCA drowning patients.
Main Methods:
- Cross-sectional sub-analysis of 3,188 pediatric drowning patients (2010-2017).
- Data collected from prehospital and medical records.
- Patients categorized by OHCA status; interventions analyzed using logistic regression.
Main Results:
- Among 213 OHCA patients, intubation vs. BVM showed no significant difference in survival or favorable neurological outcome.
- In 2,975 non-OHCA patients, supplemental oxygen did not significantly alter outcomes.
- No significant differences in outcomes were observed based on respiratory interventions.
Conclusions:
- Endotracheal intubation is not associated with improved outcomes compared to BVM in pediatric drowning with OHCA.
- Prehospital supplemental oxygen does not significantly impact outcomes in non-OHCA pediatric drowning.
- Current prehospital respiratory strategies may not significantly alter pediatric drowning resuscitation results.
Background:
Initial respiratory management is critical during drowning resuscitation. We studied the effect of prehospital airway adjuncts and supplemental oxygen on pediatric drowning outcomes.
Methods:
This cross-sectional study was a sub-analysis of children 0-18 years old who presented post-drowning to one of 32 pediatric emergency departments from 2010 to 2017. Submersion and clinical data were obtained from prehospital and medical records. Patients were categorized based on presence of out-of-hospital cardiac arrest (OHCA). Airway adjuncts included prehospital bag-valve mask (BVM) or endotracheal intubation for OHCA patients and supplemental oxygen or room air in non-OHCA patients. Primary outcomes were survival or favorable neurological outcomes at hospital discharge using Cerebral Performance Category. Covariates included demographics, body of water, bystander CPR, submersion duration, and witnessed drowning. Outcomes were compared by cardiac arrest status and respiratory intervention using logistic regression.
Results:
There were 3188 patients (No OHCA: 2975 (93%); OHCA: 213 (7%)). Median age was 3.3 years (IQR: 2.0, 5.6); 61% were male. Among OHCA patients, intubation did not have significantly different odds of favorable neurological outcome [aOR: 0.6 (95%CI: 0.1, 3.5)] or survival [aOR: 2.0 (95%CI: 0.6, 7.2)] at hospital discharge compared to BVM. No significant difference in outcomes occurred in non-cardiac arrest patients based on provision of prehospital supplemental oxygen.
Conclusion:
In pediatric patients in OHCA following drowning, endotracheal intubation was not associated with significantly different odds of favorable neurological outcome or survival at hospital discharge compared to BVM. No differences in outcomes also occurred in non-OHCA patients based on provision of prehospital supplemental oxygen.
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