Resuscitation Following Drowning

Publication Date: November 12, 2024
Last Updated: November 13, 2024

Top 10 Take-Home Messages for Resuscitation of Children Following Drowning

  1. The Drowning Chain of Survival focuses on the primary prevention of drowning, which is vitally important for children; early recognition of drowning; and considerations for safe rescue and resuscitation.
  2. Our current recommendations for drowning resuscitation support standard pediatric basic life support (BLS) and pediatric advanced life support (ALS) as the cornerstones of resuscitation.
  3. In drowning resuscitation, airway management and ventilation are of particular importance because of the continuum from respiratory arrest to cardiac arrest following drowning.
  4. Immediate initiation of rescue breathing by trained rescuers may utilize the first means available (mouth-to-mouth, pocket mask, or bag-mask ventilation).
  5. Cardiac arrest following drowning is generally the result of severe hypoxemia; therefore, oxygen administration is recommended when available.
  6. Trained rescuers should provide rescue breaths as part of cardiopulmonary resuscitation (CPR) in cardiac arrest following drowning and may initiate with breathing (airway, breathing, chest compressions) or with compressions (chest compressions, airway, breathing).
  7. Providing in-water rescue breathing, if the rescuer is appropriately trained and it’s safe to do so, may prevent the progression to cardiac arrest following drowning.
  8. The use of an automated external defibrillator (AED) after initiation of high-quality CPR may be lifesaving in cardiac arrests following drowning that present with shockable rhythms, which are a minority—especially in children.
  9. Public-access defibrillation (PAD) programs may yield important benefits when instituted in aquatic environments and large public areas where cardiac arrest may be more likely even when not the result of drowning.
  10. Knowledge gaps in drowning prevention and resuscitation require future research, especially in resource-limited regions.

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Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Resuscitation Following Drowning

Authoring Organizations

American Academy of Pediatrics

American Heart Association

Publication Month/Year

November 12, 2024

Last Updated Month/Year

November 13, 2024

Document Type

Consensus

Country of Publication

US

Document Objectives

Drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths. In the United States, drowning is the leading cause of death in children 1 to 4 years of age and second leading cause of death due to unintentional injury in those aged 5 to 14 years. Drowning generally progresses from initial respiratory arrest due to submersion-related hypoxia to cardiac arrest; thus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest due to this specific circumstance must focus on restoring breathing as much as it does circulation. Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment (eg, dry land, boat). This focused update incorporates systematic reviews from 2021 to 2023 performed by the International Liaison Committee on Resuscitation related to the resuscitation of drowning. These clinical guidelines are the product of a committee of experts representing the American Academy of Pediatrics and the American Heart Association. The writing group reviewed the recent International Liaison Committee on Resuscitation systematic reviews, including updated literature searches, prior guidelines related to resuscitation from cardiac arrest following drowning, and other drowning-related publications from the American Academy of Pediatrics and the American Heart Association. The writing group used these reviews to update its recommendations aimed at resuscitation from cardiac arrest following drowning in children.

Inclusion Criteria

Male, Female, Adolescent, Child, Infant

Health Care Settings

Childcare center, Emergency care, School

Intended Users

Athletics coaching, law enforcement, nurse, nurse practitioner, paramedic emt, physician, physician assistant

Scope

Treatment, Management, Prevention

Diseases/Conditions (MeSH)

D016887 - Cardiopulmonary Resuscitation, D004332 - Drowning, D015701 - Near Drowning

Keywords

resuscitation, Cardiopulmonary Resuscitation, CPR, Drowning

Source Citation

Tracy E. McCallin, Cameron Dezfulian, Joost Bierens, Cody L. Dunne, Ahamed H. Idris, Andrew Kiragu, Melissa Mahgoub, Rohit P. Shenoi, David Szpilman, Mark Terry, Janice A. Tijssen, Joshua M. Tobin, Alexis A. Topjian; 2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2024; e2024068444. 10.1542/peds.2024-068444