Certain clinical findings at the site of body recovery following a pediatric submersion correlate with patient outcome. This can help guide resuscitation efforts. The authors are from the University of Washington in Seattle and the University of Utah in Salt Lake City.
Age of the patients: < 20 years of age
Location: non-icy waters in Washington State
Outcomes:
(1) normal: returned to the pre-event level of function
(2) mild impairment: ataxia, dysarthria or mild neurologic residua
(3) severe impairment: spastic quadriplegia, persistent vegetative state, physically dependent for activities of daily living
(4) death
Parameters:
(1) duration of submersion
(2) duration of resuscitation attempts
(3) pupillary reactivity
(4) neurologic exam
(5) cardiac rhythm
(6) body core temperature
(7) condition upon arrival at the Emergency Department
|
Outcome |
Submersion Duration |
Resuscitation Duration Before Sinus Rhythm |
Pupils at Scene |
|
Poor |
> 10 minutes |
> 25 minutes |
nonreactive, fixed |
|
Intermediate |
6 – 10 minutes |
10 – 25 minutes |
sluggish |
|
Good |
<= 5 minutes |
< 10 minutes |
reactive |
|
Outcome |
Neurologic Exam |
Cardiac Rhythm at Scene |
Rectal Temperature |
|
Poor |
severely impaired |
asystole, ventricular fibrillation or tachycardia |
< 34°C |
|
Intermediate |
mild impairment |
|
34 - 36°C |
|
Good |
conscious and responsive at the scene |
sinus rhythm, sinus tachycardia |
euthermia (36 – 38°C) |
|
Outcome |
Condition in ED |
|
Poor |
no pulse, not breathing, fixed pupils, pH < 7.1 |
|
Intermediate |
|
|
Good |
breathing, conscious and alert, reactive pupils, pH 7.2 – 7.5 |
Conclusions on resuscitation attempts:
(1) Aggressive care may save pediatric victims in cardiac arrest after short submersion durations.
(2) Following non-icy submersions, it is appropriate to pronounce dead at the scene a child who fails to respond to CPR after 25 minutes.
Specialty: Emergency Medicine, Critical Care, Pulmonology, Pedatrics
ICD-10: ,
