Abstract
Background
Long-term outcomes after drowning-related cardiac arrest are not well characterized.
Objective
Our aims were to estimate long-term survival and identify prognostic factors in a
large, population-based cohort of drowning victims with cardiac arrest.
Methods
We conducted a population-based prospective cohort study (1974–1996) of Western Washington
Drowning Registry (WWDR) subjects with out-of-hospital cardiac arrest and attempted
professional resuscitation. The primary outcome was long-term survival through 2012.
We tabulated Utstein-style exposure variables, estimated Kaplan-Meier curves, and
identified prognostic factors with Cox proportional hazard modeling.
Results
Of 2824 WWDR cases, 407 subjects (median age 17 years [interquartile range 3–33 years],
81% were male) were included. Only 54 (13%) were still alive after 1663 person-years
of follow-up. Most deaths occurred after termination of initial resuscitation or during
initial hospitalization. Risk of subsequent death after hospital discharge was 9.6
(95% confidence interval [CI] 5.7–15.9) per 1000 person-years. Long-term survival
differed by Utstein variables (older age, illicit substance use, pre-drowning activity,
submersion duration, cardiopulmonary resuscitation duration, intubation, defibrillation,
and medications) and inpatient markers of illness severity (vital signs, Glasgow Coma
Scale, laboratory values, shock). In adjusted analyses, older age (hazard ratio [HR]
1.01; 95% CI 1.01–1.02), epinephrine administration (HR 1.92; 95% CI 1.31–2.80), antiepileptic
administration (HR 0.53; 95% CI 0.35–0.81), initial arterial pH (HR 0.49; 95% CI 0.26–0.92),
and shock (HR 2.19; 95% CI 1.16–4.15) were associated with higher risk of death.
Conclusions
Most cases of drowning-related cardiac arrest were fatal, but survivors to hospital
discharge had a low risk of subsequent death that was independently associated with
older age and clinical evidence of shock.
Keywords
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References
- Drowning.N Engl J Med. 2012; 366: 2102-2110
- Quality of cause-of-death reporting using ICD-10 drowning codes: a descriptive study of 69 countries.BMC Med Res Methodol. 2010; 10: 30
- Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1,831 cases.Chest. 1997; 112: 660-665
- Observed long-term mortality after 18,000 person-years among survivors in a large regional drowning registry.Resuscitation. 2017; 110: 18-25
- Characteristics and outcome among patients suffering out-of-hospital cardiac arrest due to drowning.Resuscitation. 2008; 76: 381-387
- Cardiac arrest due to drowning—changes over time and factors of importance for survival.Resuscitation. 2014; 85: 644-648
- Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia: Dutch nationwide retrospective cohort study.BMJ. 2015; 350: h418
- Out-of-hospital cardiac arrest due to drowning: an Utstein Style report of 10 years of experience from St. Mary's Hospital.Resuscitation. 2009; 80: 778-783
- Drowning related out-of-hospital cardiac arrests: characteristics and outcomes.Resuscitation. 2013; 84: 1114-1118
- Out-of-hospital cardiac arrest due to drowning among children and adults from the Utstein Osaka Project.Resuscitation. 2013; 84: 1568-1573
- Association of water temperature and submersion duration and drowning outcome.Resuscitation. 2014; 85: 790-794
- Trends in unintentional drowning: the role of alcohol and medical care.JAMA. 1999; 281: 2198-2202
- Intercensal and Postcensal Estimates of County Population by Age and Sex, 1980–2001.(Available at:)http://www.ofm.wa.gov/pop/census1990/bycounty.aspDate accessed: March 10, 2014
- Revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation. An ILCOR advisory statement.Resuscitation. 2017; 118: 147-158
- Assessing the outcome of pediatric intensive care.J Pediatr. 1992; 121: 68-74
- Vital Statistics of the United States, 1985. Vol. II, Sec. 6, Life Tables. DHHS Pub. No. (PHS)88-1104. Public Health Service.US Government Printing Office, Washington, DC1988
- Differential effects of out-of-hospital interventions on short- and long-term survival after cardiopulmonary arrest.Resuscitation. 2005; 67: 69-74
- Epidemiology of unintentional drowning in a metropolis of the French Mediterranean coast: a retrospective analysis (2000-2011).Int J Inj Contr Saf Promot. 2016; 23: 317-322
- Drowning mortality and morbidity rates in children and adolescents 0-19 yrs: a population-based study in Queensland, Australia.PLoS One. 2015; 10: e0117948
- Predicting outcome of drowning at the scene: a systemic review and meta-analyses.Resuscitation. 2016; 104: 63-75
- Validity of diagnostic codes for acute stroke in administrative databases: a systematic review.PLoS One. 2015; 10: e0135834
- Validity of myocardial infarction diagnoses in administrative databases: a systematic review.PLoS One. 2014; 9: e92286
- Validity of death certificates for injury-related causes of death.Am J Epidemiol. 1989; 130: 1024-1032
- Global Report on Drowning: Preventing a Leading Killer.WHO Press, Geneva, Switzerland2014
- Bystander CPR is associated with improved neurologically favorable survival in cardiac arrest following drowning.Resuscitation. 2017; 115: 39-43
- Creating a drowning chain of survival.Resuscitation. 2014; 85: 1149-1152
- Pediatric cardiac arrest due to drowning and other respiratory etiologies: neurobehavioral outcomes in initially comatose children.Resuscitation. 2017; 115: 178-184
- Strategies for using the National Death Index and the Social Security Administration for Death Ascertainment in large occupational cohort mortality studies.Am J Epidemiol. 2010; 172: 469-477
- Neurologic long-term outcome after drowning in children.Scand J Trauma Resusc Emerg Med. 2012; 20: 55
- Neurocognitive long-term follow-up study on drowned children.Resuscitation. 2014; 85: 1059-1064
Article info
Publication history
Published online: June 28, 2019
Accepted:
May 6,
2019
Received in revised form:
April 26,
2019
Received:
February 5,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
