An opportunity for a quick post to point to a new publication with something useful on drowning. From Dr Alan Garner.
Unfortunately we attend a number of paediatric drownings in the Sydney area every year. Many recover well. Some do not. Some do unexpectedly well. We have had a patient who was GCS 3 at our arrival and asystolic on the monitor make a full recovery. Most children in this situation however either die or are severely impaired.
This brings us to a vital question – when is it reasonable to stop resuscitation? Well, here’s some evidence to help inform the chat.
The Dutch Study
Over at the BMJ a new paper has just hit the screen:
This study is a nationwide observational study in the Netherlands of children with cardiac arrest due to drowning. The authors have put together ten years of data collected in a country with more than 30 million people. It seems unlikely we’ll see a bigger study.
The study indicates that no child resuscitated for more than 30 minutes had a good outcome. There were good outcomes in those resuscitated for less than 30 minutes.
This matches our experience. Our patient with the GCS 3/asystole combination and a subsequent good outcome had a return to spontaneous circulation while still on scene.
The other point of interest is that it is from an environment where water temperature is presumably a fair bit colder than the coastal fringes of Australia, but the results would appear to be similar.
It would appear that discontinuing resuscitation after 30 minutes in those with no neurological improvement or stuck in asystole is a reasonable practice.
It still comes down to time.