Bystander Resuscitation in Pediatric Drowning

Background: Drowning is a leading cause of unintentional injury death in children 1-14 years. Favorable outcomes in drowning victims occur with brief submersion duration, early cardio-pulmonary resuscitation (CPR) and shorter EMS response times. The aim of this study was to determine the effect of bystander rescue and resuscitation on pediatric drowning victim outcomes.

Methods: This was a cross-sectional study of pediatric drowning victims, aged 0-18 years, in a metropolitan area from 2010 to 2012. Submersion, prehospital, and victim data were obtained from hospital, Emergency Medical Services, and child fatality records. Unfavorable outcome was defined as death or severe impairment at hospital discharge and favorable outcome was a return to baseline status or mild impairment. Logistic regression determined factors associated with unfavorable outcome after controlling for demographics and submersion location and duration. We studied the association between the presence of a rescuing bystander and unfavorable outcome stratified by whether the victim received or did not receive bystander CPR

Results: There were 264 pediatric submersion victims aged 0-18 years in Harris County, Texas between 2010-2012. The median age was 3.2 years (IQR:1.8, 4.9). Most of the victims were males (60%) and belonged to under-represented minorities (64%). Most drownings occurred in swimming pools (78%). There were 38 victims (16%) with unfavorable outcomes at hospital discharge. Unfavorable outcome was associated with submersion duration > 5 minutes (p < 0.001). A rescuing bystander (irrespective whether CPR was performed) reduced the odds for an unfavorable outcome by 80% [aOR = 0.2(95% CI 0.07–0.6); p=0.004] when compared to non-bystanders after adjustment. Bystander CPR reduced the odds of an unfavorable outcome [aOR = 0.22 (95% CI 0.05–1.1); p=0.07] but the results were not significant.

Conclusion: Bystander rescue is associated with favorable outcomes in pediatric victims of drowning. We observed a trend towards bystander CPR reducing the likelihood of unfavorable outcomes but the results were not significant.