title: Combat-associated drowning.
abstract: BACKGROUND
  The purpose of this article is to describe the clinical course and outcome of drowning cases related to current US military combat operations.
  
  
  METHODS
  This retrospective case series spans December 2002 to January 2009 of survivors transferred to an echelon IV military trauma center in Europe serving as the primary evacuation hub for ongoing combat operations. Patient demographics and the situational and clinical findings at the initial drowning scene were reviewed. A comprehensive analysis of care as each patient transitioned through the combat theater to the echelon IV trauma center in Europe was performed.
  
  
  RESULTS
  Overall, mortality was 37.5% mortality rate (3 of 8 patients). Advanced modes of respiratory support such as high-frequency ventilation, airway pressure release ventilation, and extracorporeal membrane oxygenation were required in a majority of the cohort (6 of 8 patients). Limited-duration vasopressor infusions (7 of 8 patients) were also required to ensure adequate end-organ perfusion. Glasgow Coma Scale (GCS) scores and the need for cardiopulmonary resuscitation (CPR) at the scene of injury were associated with eventual patient mortality (100% mortality for an initial GCS score of 3 and 75% mortality for on-scene CPR). Survivor long-term morbidity was often related to the sequelae of acute respiratory distress syndrome and hypoxic encephalopathy.
  
  
  CONCLUSIONS
  Drowning associated with combat operations was associated with severe acute respiratory distress syndrome and cardiovascular shock. GCS score and the need for CPR at the scene of injury were associated with eventual mortality because of anoxic brain injury in all cases.
authors.affiliation: Landstuhl Regional Medical Center, Landstuhl, Germany.
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Allan
authors.forename: Raymond
authors.initials: R
authors.lastname: Fang
authors.forename: Kathleen D
authors.initials: KD
authors.lastname: Martin
authors.forename: Michael
authors.initials: M
authors.lastname: Glenn
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Conger
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004332:Drowning / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D015701:Near Drowning / Q000628:therapy; D012189:Retrospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology; D014857:Warfare; D055815:Young Adult