Morbidity of Childhood Near-Drowning

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Abstract
An assessment of morbidity in near-drowning was made from a review of emergency room and hospital records of 72 patients, ages 9 mo.-20 yr, who suffered near-drowning during the period Jan. 1972-June 1974. Fifteen patients (21%) evidenced severe anoxic encephalopathy; the remainder had no detectable neurologic deficits. Hypoxemia was demonstrated in 56 patients. Severe acidosis was not present unless respiratory failure occurred. Neither electrolytes, red blood cell hemolysis nor cardiac arrhythmias presented a problem. Respiratory complications included pulmonary edema, aspiration pneumonia, atelectasis, shock lung, pneumothorax and pneumomediastinum. All children requiring cardiopulmonary resuscitation (CPR) in the emergency room suffered anoxic encephalopathy. The occurrence of seizures, fixed and dilated pupils, flaccid extremities, and lack of response to deep pain in the emergency room had almost universal correlation with resultant severe anoxic encephalopathy, as did a submersion period of 6 or more minutes. The morbidity of near-drowning is significant with regard to the number of children affected and the severity of the CNS insult received. The statement by the American Heart Association that resuscitative efforts in children should be continued for periods longer than 10 min needs reevaluation, since neurologic recovery did not occur in any child requiring CPR in the emergency room. More importantly, new methods of cerebral resuscitation need to be developed and established. Medical personnel need to think in terms of cardiopulmonary cerebral resuscitation (CPCR) rather than in terms of CPR.

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