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Effect of immediate resuscitation on children with submersion injury
D N Kyriacou1, E L Arcinue, C Peek
1Olive View/UCLA Medical Center, Department of Emergency Medicine, Sylmar 91342.
Insights
Immediate resuscitation significantly improves neurological outcomes for children with submersion injuries. Early efforts by bystanders or rescuers reduce the risk of severe brain damage or death in drowning incidents.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Resuscitation Science
Background:
- Submersion injuries in children can lead to severe neurological deficits or death.
- Prompt medical intervention is crucial for improving outcomes in pediatric drowning cases.
Purpose of the Study:
- To evaluate the impact of immediate resuscitative efforts on the neurological outcomes of children experiencing submersion injuries.
- To determine if pre-hospital resuscitation influences the frequency of severe neurological damage or mortality in pediatric submersion events.
Main Methods:
- A case-control study involving 166 children (0-14 years) with documented submersion events.
- Logistic regression analysis was employed to calculate adjusted odds ratios for neurological outcomes.
- Data on resuscitation, submersion duration, hypothermia, and apnea were collected and analyzed.
Main Results:
- Children receiving immediate resuscitation were 4.75 times more likely to have a good neurological outcome compared to those without.
- Cardiopulmonary resuscitation (CPR) and mouth-to-mouth resuscitation demonstrated the highest efficacy in preventing death or severe anoxic encephalopathy.
- Immediate resuscitation before emergency medical services arrival was strongly associated with better neurological outcomes.
Conclusions:
- Early resuscitative interventions are critical for improving neurological outcomes in pediatric submersion injuries.
- The findings underscore the importance of bystander and rescuer CPR in mitigating the severity of drowning-related brain injury.
Study Objective:
To determine the effect of immediate resuscitative efforts on the neurological outcome of children with submersion injury.
Design:
A case-control study was designed to determine if immediate resuscitation by rescuers or bystanders reduces the frequency of severe neurological damage or death in children with a documented submersion event. Logistic regression was used calculate an adjusted odds ratio.
Participants:
The study group consisted of 166 children, aged zero to 14 years, having a submersion event during May 1984 through August 1992, and admitted through various emergency departments to Huntington Memorial Hospital in Pasadena, California.
Measurements And Main Results:
All study subjects had an observed and documented episode of apnea at the time of submersion. Outcomes were evaluated on the basis of neurological impairment or death. Exposure was verified from historical accounts of postsubmersion events provided by family, friends, and/or paramedical personnel. The study factors included age and gender, duration of submersion, hypothermia, presence of apnea, resuscitative efforts, and clinical outcome. Children with a good outcome were 4.75 (adjusted odds ratio (OR)) times more likely to have a history of immediate resuscitation than children with poor outcome (95% confidence interval: 3.44 < OR < 6.06, P = .0001). Various types of resuscitative efforts and potential confounding factors were also evaluated. CPR and mouth-to-mouth resuscitation were the most effective types for the prevention of death or severe anoxic encephalopathy.
Conclusion:
Immediate resuscitation before the arrival of paramedical personnel is associated with a significantly better neurological outcome in children with submersion injury.