Definition and additional facts

• Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid
• The third leading cause of unintentional death 
• 360,000 drowning victims annually worldwide
• Submersion time is the strongest predictor of outcome
• Patients require a trauma/ATLS approach
• Problem: survival after cardiac arrest from drowning-related asphyxia is rare
  •  100% mortality = submersion > 25 min, resuscitation > 25 min, pulseless on arrival to ER, unconscious at the scene and on arrival to ED
• Most survivors sustain severe CNS injury

Mechanisms of injury

• Hypoxia due to inhalation of fluid in the lungs, potentially leading to cardiac arrest
• Hypothermia:
  • Coagulopathy
  • Arrhythmias
  • Hypovolemia
  • Rewarming technique
  • Electrolyte abnormalities
• Coagulopathy:
  • Arrhythmias
  • Hypovolemia
  • Rewarming technique
  • Electrolyte abnormalities

Management

Suggested reading

• Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152-219.