Pre-hospital Management

Survival after drowning depends on a well-functioning chain of survival, starting outside the hospital and continuing in-hospital during the post-resuscitation phase. Prehospital care personnel provide the opportunity to perform rapid rescue from submersion events. Reestablishing ventilation before cardiac arrest nearly assures no long-term neurological sequelae [1, 2]. However, if the drowning victim sustains cardiac arrest, CPR provides the best chance of neurological recovery. Controversy exists over the optimal method for performing CPR. Research suggests that bystander chest compressions alone may be better than rescue breathing combined with chest compressions (standard CPR) for resuscitating patients with sudden cardiac death [3]. These studies excluded drowning victims and others with an asphyxial cause of cardiac arrest. Unlike sudden cardiac death, drowning victims asphyxiate which leads to cardiac arrest, so maximizing oxygenation in addition to perfusion during CPR may improve outcome [4, 5]. Two prospective, population-based cohort studies support performing standard CPR for drowning victims (rescue breathing and chest compressions) [6, 7] and bystanders may play an important role [8]. Thus, it is recommended that drowning victims with no signs of life be provided chest compressions with rescue breathing rather than compression CPR alone.