Near drowning: a case study of a 31-year-old woman.
Huckabee HC, Craig PL, Williams JM.
University of Alaska, Anchorage, USA.
A 31-yr-old woman demonstrated intact neuropsychological functioning after being submerged for at least 30 minutes in icy cold water. Following submersion, the patient received CPR for approximately 1 hr. Eight hours after submersion, the patient's temperature was 31 degrees C (87 degrees F). She remained nonresponsive for 2 days after the accident. Extensive neuropsychological testing was completed 3 mo after the accident with no objective or subjective deficits evidenced. This case of hypothermically mediated neuroprotection from anoxia in an adult supports the need for further research on the putative neurophysiological mechanisms invoked and the potential for application of clinically induced hypothermia in the acute management of other types of cerebral insults.
Publication Types:
• Case Reports
PMID: 9375192 [PubMed - indexed for MEDLINE]
• Chochinov AH,
• Baydock BM,
• Bristow GK,
• Giesbrecht GG.
Department of Family Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Recovery from prolonged cold water submersion is well documented in children but rare in adults. In the few adult cases reported, significant body cooling occurred (rectal temperature ranging from 22 degrees to 32 degrees C) and the victims were relatively young (< 40 years). We report a case of a 62-year-old man who was submersed in 2 degrees to 3 degrees C water for 15 minutes (time from initial submersion to intubation = 22 minutes). At the time of rescue, he had no vital signs, received prehospital Advanced Life Support, and was transported to hospital. On arrival at hospital, the patient remained in full cardiopulmonary arrest with an agonal ECG rhythm and had an initial pH of 6.77. Initial rectal temperature was near normal (36 degrees C) but subsequently dropped to 33 degrees C. The patient was resuscitated, rewarmed by forced-air warming, and treated for acute myocardial infarction, pulmonary edema, and generalized seizures. He was discharged after 27 days with minor neurologic abnormalities. Given the near-normal initial rectal temperature, preferential brain cooling may have been at least partially responsible for the positive neurologic outcome.
PMID: 9437357 [PubMed - indexed for MEDLINE]
• Suominen P,
• Baillie C,
• Korpela R,
• Rautanen S,
• Ranta S,
• Olkkola KT.
Department of Anaesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki University Central Hospital, Stenbackinkatu 9, FIN-00029 HUS, Helsinki, Finland.
pertti.suominen@hus.fi
BACKGROUND: Because children have less subcutaneous fat, and a higher surface area to body weight ratio than adults, it has been suggested that children cool more rapidly during submersion, and therefore have a better outcome following near-drowning incidents. AIM OF THE STUDY: To study the impact of age, submersion time, water temperature and rectal temperature in the emergency room on outcome in near-drowning. MATERIAL AND METHODS: This retrospective study included all near-drowning victims admitted to the intensive care units of Helsinki University Central Hospital after successful cardiopulmonary resuscitation between 1985 and 1997. RESULTS: There were 61 near-drowning victims (age range: 0.5-60 years, median 29 years). Males were in the majority (40), and 26 were children (<16 years). The median water temperature was 17 degrees C (range: 0-33 degrees C). The median submersion time for the 43 survivors (70%) was 10 min (range: 1-38 min). Intact survivors and those with mild neurological disability (n=26, 43%) had a median submersion time of 5 min (range: 1-21 min). In non-survivors the median submersion time was 16 min (range: 2-75 min). Submersion time was the only independent predictor of survival in linear regression analysis (P<0.01). Patient age, water temperature and rectal temperature in the emergency room were not significant predictors of survival. CONCLUSIONS: Although submersion time is usually an estimate, it is the best prognostic factor after a near drowning incident. Children did not have a better outcome than adults.
PMID: 11886729 [PubMed - indexed for MEDLINE]
• Genoni L,
• Domenighetti G.
Cardiopulmonary resuscitation was successful in a healthy 29-year-old woman who had been submerged for 20 minutes in water at 10 degrees C. The evolution was characterized by the development of a multifactorial ARDS (secondary drowning) and sepsis caused by Aeromonas hydrophila and Acinetobacter anitratum. Fibrosing alveolitis caused a restrictive syndrome with severe mechanical impairment and transitory therapy-resistant hypoxemia. It is suggested that prolonged submersion in cold water is also a treatable and completely reversible condition in adults. In our patient without neurological sequelae the pulmonary function studies after 3 months show complete recovery from the mechanical impairment. After a follow-up period of 11 months only mild abnormalities of gas exchange persist.
PMID: 6287569 [PubMed - indexed for MEDLINE]
• umle B,
• Doring B,
• Mertes H,
• Posival H.
Klinik fur Anasthesiologie und operative Intensivmedizin, Klinkum der Stadt Ludwigshafen.
We report on a 21-year old patient who nearly drowned in cold water under inexplicable circumstances. About 1/2 hour later he was found with cardiac arrest. Immediate cardiopulmonary resuscitation remained unsuccessfully but was continued. After transportation to the nearest hospital a core temperature of 26.1 degrees C was recorded. A team of our hospital arrived 2 1/2 hours after start of cardiopulmonary resuscitation. After introducing a femo-femoral bypass the patient was rapidly rewarmed and oxygenated using a portable extracorporeal circulation and membrane oxygenation. Defibrillation succeeded at a core temperature of 34.4 degrees C. A severe ARDS developed the same day which was successfully treated by membrane oxygenation. 41 days later the patient left the hospital fully recovered.
PMID: 9498097 [PubMed - indexed for MEDLINE]
• Sumann G,
• Krismer AC,
• Wenzel V,
• Adelsmayr E,
• Schwarz B,
• Lindner KH,
• Mair P.
Departments of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria.
Recent animal data have challenged the common clinical practice to avoid vasopressor drugs during hypothermic cardiopulmonary resuscitation (CPR) when core temperature is below 30 degrees C. In this report, we describe the case of a 19-year-old-female patient with prolonged, hypothermic, out-of-hospital cardiopulmonary arrest after near drowning (core temperature, 27 degrees C) in whom cardiocirculatory arrest persisted despite 2 mg of intravenous epinephrine; but, immediate return of spontaneous circulation occurred after a single dose (40 IU) of intravenous vasopressin. The patient was subsequently admitted to a hospital with stable haemodynamics, and was successfully rewarmed with convective rewarming, but died of multiorgan failure 15 h later. To the best of our knowledge, this is the first report about the use of vasopressin during hypothermic CPR in humans. This case report adds to the growing evidence that vasopressors may be useful to restore spontaneous circulation in hypothermic cardiac arrest patients prior to rewarming, thus avoiding prolonged mechanical CPR efforts, or usage of extracorporeal circulation. It may also support previous experience that the combination of both epinephrine and vasopressin may be necessary to achieve the vasopressor response needed for restoration of spontaneous circulation, especially after asphyxial cardiac arrest or during prolonged CPR efforts.
PMID: 12648206 [PubMed - indexed for MEDLINE]
Article in French]
• Incagnoli P,
• Bourgeois B,
• Teboul A,
• Laborie JM.
Service d'anesthesie cardiovasculaire, departement d'anesthesie-reanimation-II, CHU de Grenoble, hopital Michallon, BP 207, 38043 Grenoble cedex 09, France.
pincagnoli@club-internet.fr
In winter, French Medicalised Ambulance Service rescued a 50-year-old patient after suicide attempts by jump from a bridge in the Seine. The body was discovered after more than 10 minutes of immersion. She was unconscious and in deep hypothermia with circulatory arrest. Basic CPR was started immediately and oral intubation and 100% oxygen ventilation was performed. Ventricular fibrillation appeared but repeated defibrillation failed due to profound hypothermia (rectal temperature: 28 degrees C). The patient was immediately transported to hospital. CPR and mechanical ventilation was continued during transport. The patient was taken in emergency room. The oesophageal temperature was 22 degrees C. Rewarming using extracorporeal circulation was immediately initiated after insertion of femoral access. At 27 degrees C, ventricular fibrillation started and was converted by external defibrillation to a pulse-generating cardiac rhythm. At 360 minutes, the patient's rectal temperature had reached 36 degrees C and she was disconnected from cardiopulmonary bypass with inotropic support. She was transferred to the intensive care unit after 9 hours of resuscitation, rewarming and stabilisation. Mechanical ventilation was needed for 15 days because of adult respiratory distress syndrome. Renal failure, pneumonia also occurred. She was successfully extubated on day 15 and was discharged from intensive care unit on day 21, suffering no neurological side effects.
PMID: 16516435 [PubMed - indexed for MEDLINE]
• Mahoney PF,
• Williams L,
• Andrews JI.
District General Hospital, Sunderland.
A case of a 24-year-old male who survived a near drowning despite suboptimal pre-hospital management is reported. The case illustrates the value of continuing resuscitative efforts even in the apparently dead drowning victim.
PMID: 8329080 [PubMed - indexed for MEDLINE]
