Pivotal role of bystander cardiopulmonary resuscitation in pediatric drowning incidents

Background

The earliest possible provision of basic and advanced life support techniques are traditionally emphasized for resuscitation in drowning incidents. However, previous studies have also indicated that performance of cardiopulmonary resuscitation (CPR) by bystanders is particularly critical in drowning. The purpose of this study was to evaluate, in a prospective manner, the relative contribution of bystander CPR in terms of ultimate survival following critical drowning events in children.

Methods

From 1990 to 1999, all 9-1-1 incidents related to childhood (ages 0–14 years) drowning events were examined prospectively in a metropolitan US sunbelt city (population 2 million) using a comprehensive Utstein-style database. The at-risk population (ages 0–14 years) averaged 418,000 during the study.

Results

In the finite population studied, two-thirds of all (adult and child) submersion incidents involved children, totaling 420 cases (mean = 42 children/year; annual incidence = 10.0 per 100,000), with 72% (n = 303) occurring in those aged 5 years or younger (20.2 per 100,000/year). In certain years, this younger cohort comprised as many as 87% of cases. Most cases (65%) occurred in summer and 83% between 12:00 and 8:00 pm (none 12:00–7:00 am). The site was a pool in 75% of cases (n = 317) with 64% of these at apartments. Only 19% involved tubs/spas (annual range = 6–34%) and 5% were in buckets, toilets, bayous, lakes, and creeks. Of the 420 total cases, one child was found dead on-scene and 234 clearly required resuscitative efforts (using strict criteria). Bystanders performed CPR in 82% of these resuscitation cases (n = 193) and 72% of these children survived long-term (99% neurologically intact). However, if a child remained apneic/pulseless by the time emergency services arrived (average response = 5 min), less than 5% were revived (none neurologically intact). Of 94 total deaths, two-thirds occurred in pools.

Conclusions

In certain venues, submersion incidents can account for a large number of per-capita childhood deaths, and immediate basic bystander CPR, not advanced life support, is the most definitive resuscitative action for children with drowning-related incidents. Considering that most drowning incidents in this study occurred in residential pools and in those aged 5 years or younger, supervision, safety barriers and knowledge/performance of bystander CPR appear to be the major factors in prevention of childhood drowning deaths.