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Brain resuscitation in the drowning victim.
Topjian-AA; Berg-RA; Gierens-JJLM; Branche-CM; Clark-RS; Friberg-H; Hoedemaekers-CWE; Holzer-M; Katz-LM; Knape-JTA; Kochanek-PM; Nadkarni-V; van der Hoeven-JG; Warner-DS
Neurocrit Care 2012 Dec; 17(3):441-467
Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidencebased consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32-34 oC) considered. Arterial hypotension/ hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brainoriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/ reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders.
Brain-damage; Brain-function; Neurological-system; Epidemiology; Biomarkers; Cardiac-function; Hypothermia; Hyperthermia; Electroencephalography; Monitoring-systems; Central-nervous-system; Author Keywords: Drowning; Brain; Asphyxia; Cardiac arrest
Alexis Topjian, The Children's Hospital of Philadelphia, 7th floor, 34th Street and Civic Center Boulevard, Suite 7C23, Philadelphia, PA 19104
Issue of Publication
Page last reviewed: May 5, 2020
Content source: National Institute for Occupational Safety and Health Education and Information Division