The American Heart Association and the American Academy of Paediatrics have updated their recommendations for untrained lay rescuers and trained rescuers resuscitating adults and children who have drowned.
The focused update to Special Circumstances Guidelines highlights the importance of compressions with rescue breaths as a first step in response.
The two organisations have previously partnered on neonatal guidelines, however, this is the first collaboration on resuscitation after drowning.
The recommendations were published simultaneously in the peer-reviewed journals of each organisation, Circulation and Paediatrics.
The publication in Paediatrics focuses on resuscitation of children after drowning and references paediatric literature, while the publication in Circulation is for resuscitation of both adults and children and includes literature addressing both populations.
Drowning is the third leading cause of death from unintentional injury worldwide. The WHO estimates there are about 236 000 deaths from drowning each year globally.
“The focused update contains the most up-to-date, evidence-based recommendations on how to resuscitate someone who has drowned, offering practical guidance for healthcare professionals, trained rescuers, caregivers and families," said writing group Co-Chair Tracy E McCallin, MD, FAAP, associate professor of paediatrics in the division of paediatric emergency medicine at Rainbow Babies and Children's Hospital in Cleveland.
Drowning generally progresses quickly from initial respiratory arrest to cardiac arrest, and as a result, blood cannot circulate properly throughout the body, and it is starved of oxygen.
“CPR for cardiac arrest due to drowning must focus on restoring breathing as well as restoring blood circulation,” said writing group Co-Chair Cameron Dezfulian, MD, FAHA, FAAP, senior faculty in paediatrics and critical care at Baylor College of Medicine in Houston.
Cardiac arrest after drowning is usually due to severe hypoxia, or low blood oxygen levels, Dezfulian said. “This differs from sudden cardiac arrest from a cardiac cause where the individual generally collapses with fully oxygenated blood.”
The update also highlights the Drowning Chain of Survival, which includes the steps needed to improve chances of survival: prevention, recognition and safe rescue.
Prevention
It has been estimated that more than 90% of all drownings are preventable. Research has found most infants drown in bathtubs, and most preschool-aged children drown in swimming pools.
The guideline update recommends that appropriately trained rescuers, such as lifeguards, swim instructors or first responders, should provide in-water rescue breathing to an unresponsive person who has drowned if it does not compromise their own safety.
This guideline update supersedes the American Heart Association's prior recommendations for drowning, issued in 2020 and serves as a complement to the American Academy of Paediatrics 2021 Prevention of Drowning technical report and the related 2019 Prevention of Drowning policy statement.
Study details
2024 American Heart Association and American Academy of Paediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular care
Cameron Dezfulian, Tracy E. McCallin, Joost Bierens, et al
Published in Circulation on 12 November 2024
Abstract
Drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths. The WHO estimates that there are ≈236 000 deaths due to drowning worldwide annually. Significant efforts have focused on creating systems to prevent drowning, but an average of 4000 fatal and 8000 nonfatal drownings still occur annually in the United States – likely an underestimate. Drowning generally progresses from initial respiratory arrest due to submersion-related hypoxia to cardiac arrest; thus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest attributable to this specific circumstance must focus on restoring breathing as much as it does circulation. Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment. This focused update incorporates systematic reviews from 2021 to 2023 performed by the International Liaison Committee on Resuscitation related to the resuscitation of drowning. These clinical guidelines are the product of a committee of experts representing the American Heart Association and the American Academy of Paediatrics. The writing group reviewed the recent International Liaison Committee on Resuscitation systematic reviews, including updated literature searches, prior guidelines related to resuscitation from cardiac arrest following drowning, and other drowning-related publications from the American Heart Association and American Academy of Paediatrics. The writing group used these reviews to update its recommendations aimed at resuscitation of cardiac arrest following drowning in adults and children.
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