title: Outcome of 12 drowned children with attempted resuscitation on cardiopulmonary bypass: an analysis of variables based on the "Utstein Style for Drowning".
abstract: BACKGROUND
  In 2003, the International Liaison Committee on Resuscitation (ILCOR) published the "Utstein Style for Drowning" (USFD) to advance knowledge on the epidemiology, treatment, and outcome prediction after drowning. Applying the USFD and evaluating its data template for outcome analysis, we report here on the largest study published thus far of drowned children (age 0-14) who underwent attempted resuscitation on cardiopulmonary bypass (CPB).
  
  
  METHODS
  We conducted a retrospective review of all drowned children admitted to Göttingen University Hospital between 1/1987 and 12/2005 in sustained cardiopulmonary arrest and resuscitation with CPB. We correlated eight outcome-affecting USFD variables and four additional variables not included in the USFD with potential impact on outcome to four outcome groups: survival, non-survival, survival with full recovery, and failed resuscitation.
  
  
  RESULTS
  Out of 12 children (aged 22 months to 7.5 years), 5 survived to hospital discharge and 7 died in hospital. Two survivors recovered fully and three remained in a vegetative state. In two patients, resuscitation on CPB failed. Both children who fully recovered, compared to the 10 others, had relatively low serum K+ concentrations (2.6 and 3.7 mmol/l versus 5.8+/-3.8 mmol/l [mean+/-S.D.; n=10]), a relatively slow rewarming speed (1.9 and 1.2 degrees C/h versus 3.4+/-1.8 degrees C/h), were female (all three girls survived), received early basic life support (BLS) and showed idioventricular bradycardia. Both children with failed resuscitation had severe hyperkalaemia (11.7 and 13.3 mmol/l versus 10 others, 4.0+/-1.5 mmol/l), were relatively rapidly rewarmed (6.9 and 4.0 degrees C/h versus 10 others, 2.61+/-1.32 degrees C/h), male, and in asystole. We identified no outcome trends for age, pH, or water and core temperatures.
  
  
  CONCLUSIONS
  Most variables relevant for outcome in drowned children can be documented with the use of the USFD. Additional variables not included in the USFD that have emerged from this study and may predict outcome include serum K+ concentration, rewarming speed, and initial cardiac rhythm.
authors.affiliation: Department of Anaesthesiology, Emergency and Intensive Care Medicine, Georg-August University, Göttingen, Germany. ceich@zari.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Eich
authors.forename: Anselm
authors.initials: A
authors.lastname: Bräuer
authors.forename: Arnd
authors.initials: A
authors.lastname: Timmermann
authors.forename: Stephan K W
authors.initials: SK
authors.lastname: Schwarz
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: Russo
authors.forename: Karin
authors.initials: K
authors.lastname: Neubert
authors.forename: Bernhard M
authors.initials: BM
authors.lastname: Graf
authors.forename: Ivan
authors.initials: I
authors.lastname: Aleksic
mesh_terms: D000293:Adolescent; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D004332:Drowning / Q000401:mortality / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D020127:Recovery of Function; D012151:Resuscitation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome