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Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada

Published online by Cambridge University Press:  04 March 2015

Jason E. Buick ,
Steve Lin ,
Valeria E. Rac ,
Steven C. Brooks ,
Gérald Kierzek  and
Laurie J. Morrison
Jason E. Buick
Affiliation:
Rescu, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
Steve Lin
Affiliation:
Rescu, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON
Valeria E. Rac
Affiliation:
Rescu, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON
Steven C. Brooks
Affiliation:
Rescu, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON Department of Emergency Medicine, Queen's University, Kingston, ON
Gérald Kierzek
Affiliation:
Emergency Department, EMS, and Forensic Emergency Medicine, Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
Laurie J. Morrison*
Affiliation:
Rescu, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON
*
Rescu, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8; [email protected]

Abstract

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Introduction:

Drowning is a major public health concern, yet little is known about the characteristics of drowning patients. The objectives of this study were to describe the demographic and clinical characteristics of out-of-hospital cardiac arrest (OHCA) attributed to drowning in Ontario and to compare the characteristics of OHCA attributed to drowning to those of presumed cardiac etiology.

Methods:

A retrospective, observational study was carried out of consecutive OHCA patients of drowning etiology in Ontario between August 2006 and July 2011. Bivariate analysis was used to evaluate differences between drowning and presumed cardiac etiologies.

Results:

A total of 31,763 OHCA patients were identified, and 132 (0.42%) were attributed to drowning. Emergency medical services treated 98 patients, whereas the remaining 34 met the criteria for legislative death. Overall, 5.1% of drowning patients survived to hospital discharge. When compared to patients of presumed cardiac etiology, drowning patients were younger and their arrest was more likely to be unwitnessed, present with a nonshockable initial rhythm, occur in a public location, and receive bystander cardiopulmonary resuscitation (CPR). A nonsignificant trend was noted for drowning cases to more frequently have a public access AED applied. There were no significant differences in the gender ratio or paramedic response times. Drowning patients were more likely to be transported to hospital but had a trend to be less likely to arrive with a return of spontaneous circulation. They were also morelikely to be admitted to hospital but had no difference in survival to hospital discharge.

Conclusions:

Significant differences exist between OHCA of drowning and presumed cardiac etiologies. Most drownings are unwitnessed, occur in public locations, and present with nonshockable initial rhythms, suggesting that treatment should focus on bystander CPR. Future initiatives should focus on strategies to improve supervision in targeted locations and greater emphasis on bystander-initiated CPR, both of which may reduce drowning mortality.

Keywords

cardiopulmonary resuscitationemergency medical servicesdrowningout-of-hospital cardiac arrest
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 4 , July 2014 , pp. 314 - 321
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Idris, AH, Berg, RA, Bierens, J, et al. Recommended guidelines for uniform reporting of data from drowning: the “Utstein style.” Circulation 2003;108:2565–74, doi:10.1161/01.CIR.0000099581.70012.68.Google Scholar
2. Papa, L, Hoelle, R, Idris, A. Systematic review of definitions for drowning incidents. Resuscitation 2005;65:255–64, doi:10.1016/j.resuscitation.2004.11.030.Google Scholar
3. Peden, MM, McGee, K. The epidemiology of drowning worldwide. Inj Control Saf Promot 2003;10:195–9, doi:10.1076/icsp.10.4.195.16772.Google Scholar
4. Lifesaving Society. National drowning report – 2011 edition. Ottawa; Lifesaving Society; 2011.Google Scholar
5. Canadian Red Cross. Water safety services. What we have learned: 10 years of pertinent facts about drownings and otherwater-related injuries in Canada. Ottawa: Canadian Red Cross; 2003.Google Scholar
6. Hess, EP, Campbell, RL, White, RD. Epidemiology, trends, and outcome of out-of-hospital cardiac arrest of non-cardiac origin. Resuscitation 2007;72:200–6, doi:10.1016/j.resuscitation.2006.06.040.Google Scholar
7. Claesson, A, Svensson, L, Silfverstolpe, J, et al. Characteristics and outcome among patients suffering out-of-hospital cardiac arrest due to drowning. Resuscitation 2008;76:381–7, doi:10.1016/j.resuscitation.2007.09.003.CrossRefGoogle ScholarPubMed
8. Tyebally, A, Ang, SY. Kids can’t float: epidemiology of paediatric drowning and near-drowning in Singapore. Singapore Med J 2010;51:429–33.Google ScholarPubMed
9. Quan, L, Kinder, D. Pediatric submersions: prehospital predictors of outcome. Pediatrics 1992;90:909–13.Google Scholar
10. Somers, GR, Chiasson, DA, Smith, CR. Pediatric drowning: a 20-year review of autopsied cases: I. Demographic features. Am J Forensic Med Pathol 2005;26:316–9, doi:10.1097/01.paf.0000188094.09946.05.CrossRefGoogle Scholar
11. Brenner, RA, Trumble, AC, Smith, GS, et al. Where children drown, United States, 1995. Pediatrics 2001;108:85–9, doi:10.1542/peds.108.1.85.Google Scholar
12. Papadodima, SA, Sakelliadis, EI, Kotretsos, PS, et al. Cardiovascular disease and drowning: autopsy and laboratory findings. Hellenic J Cardiol 2007;48:198–205.Google Scholar
13. Ballesteros, MA, Gutierrez-Cuadra, M, Munoz, P, et al. Prognostic factors and outcome after drowning in an adult population. Acta Anaesthesiol Scand 2009;53:935–40, doi:10.1111/j.1399-6576.2009.02020.x.Google Scholar
14. Quan, L, Cummings, P. Characteristics of drowning by different age groups. Inj Prev 2003;9:163–8, doi:10.1136/ip.9.2.163.Google Scholar
15. Grmec, S, Strnad, M, Podgorsek, D. Comparison of the characteristics and outcome among patients suffering from out-of-hospital primary cardiac arrest and drowning victims in cardiac arrest. Int J Emerg Med 2009;2:7–12, doi:10.1007/s12245-009-0084-0.Google Scholar
16. Deakin, CD. Drowning: more hope for patients, less hope for guidelines. Resuscitation 2012;83:1051–2, doi:10.1016/j.resuscitation.2012.06.004.CrossRefGoogle ScholarPubMed
17. Morrison, LJ, Nichol, G, Rea, TD, et al. Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Resuscitation 2008;78:161–9, doi:10.1016/j.resuscitation.2008.02.020.Google Scholar
18. Cummins, RO, Chamberlain, DA, Abramson, NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991;84:960–75, doi:10.1161/01.CIR.84.2.960.Google Scholar
19. Jacobs, I, Nadkarni, V, Bahr, J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation 2004; 110:3385–97, doi:10.1161/01.CIR.0000147236.85306.15.Google Scholar
20. Morrison, LJ, Verbeek, PR, Zhan, C, et al. Validation of a universal prehospital termination of resuscitation clinical prediction rule for advanced and basic life support providers. Resuscitation 2009;80:324–8, doi:10.1016/j.resuscitation.2008.11.014.Google Scholar
21. Morrison, LJ, Visentin, LM, Kiss, A, et al. Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest. N Engl J Med 2006;355:478–87, doi:10.1056/NEJMoa052620.Google Scholar
22. Natural Resources Canada. The atlas of Canada. Ottawa: Natural Resources Canada; 2009. Available at: (accessed April 21, 2011).Google Scholar
23. Eich, C, Brauer, A, Timmermann, A, et al. Outcome of 12 drowned children with attempted resuscitation on cardiopulmonary bypass: an analysis of variables based on the “Utstein Style for Drowning.” Resuscitation 2007;75:42–52, doi:10.1016/j.resuscitation.2007.03.013.Google Scholar
24. Venema, AM, Groothoff, JW, Bierens, JJ. The role of bystanders during rescue and resuscitation of drowning victims. Resuscitation 2010;81:434–9, doi:10.1016/j.resuscitation.2010.01.005.Google Scholar
25. Youn, CS, Choi, SP, Yim, HW, et al. Out-of-hospital cardiac arrest due to drowning: an Utstein Style report of 10 years of experience from St. Mary’s Hospital. Resuscitation 2009;80:778–83, doi:10.1016/j.resuscitation.2009.04.007.Google Scholar
26. Layon, AJ, Modell, JH. Drowning: update 2009. Anesthesiology 2009;110:1390–401, doi:10.1097/ALN.0b013e3181a4c3b8.CrossRefGoogle ScholarPubMed
27. Vanden Hoek, TL, Morrison, LJ, Shuster, M, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S829–61, doi:10.1161/CIRCULATIONAHA.110.971069.Google Scholar
28. Modell, JH. Prevention of needless deaths from drowning. South Med J 2010;103:650–3, doi:10.1097/SMJ.0b013e3181e10564.Google Scholar
29. Yang, L, Nong, QQ, Li, CL, et al. Risk factors for childhood drowning in rural regions of a developing country: a casecontrol study. Inj Prev 2007;13:178–82, doi:10.1136/ip.2006.013409.Google Scholar
30. Brenner, RA, Taneja, GS, Haynie, DL, et al. Association between swimming lessons and drowning in childhood: a case-control study. Arch Pediatr Adolesc Med 2009;163:203–10, doi:10.1001/archpediatrics.2008.563.CrossRefGoogle ScholarPubMed
31. Ahmed, MK, Rahman, M, van Ginneken, J. Epidemiology of child deaths due to drowning in Matlab, Bangladesh. Int J Epidemiol 1999;28:306–11, doi:10.1093/ije/28.2.306.CrossRefGoogle ScholarPubMed
32. Breckwoldt, J, Schloesser, S, Arntz, HR. Perceptions of collapse and assessment of cardiac arrest by bystanders of out-of-hospital cardiac arrest (OOHCA). Resuscitation 2009; 80:1108–13, doi:10.1016/j.resuscitation.2009.06.028.Google Scholar