title: Effectiveness and safety of in-water resuscitation performed by lifeguards and laypersons: a crossover manikin study.
abstract: OBJECTIVE
  Drowning is associated with a high mortality and morbidity and a common cause of death. In-water resuscitation (IWR) in the case of drowning accidents has been recommended by certain resuscitation guidelines in the last several years. IWR has been discussed controversially in the past, especially with regard to the delay of chest compressions, effectiveness of ventilation, and hazard to the rescuer. The aim of the present study was to assess the effectiveness and safety of IWR.
  
  
  METHODS
  In this crossover manikin study, 21 lifeguards and 21 laypersons performed two rescue procedures in an indoor swimming pool over a 50-meter distance: In random order, one rescue procedure was performed with in-water ventilation and one without. Tidal and minute volumes were recorded using a modified Laerdal Resusci Anne (Laerdal Medical, Stavanger, Norway) and total rescue duration, submersions, water aspiration by the victim, and physical effort were assessed.
  
  
  RESULTS
  IWR resulted in significant increases in rescue duration (lifeguards: 106 vs. 82 seconds; laypersons: 133 vs. 106 seconds) and submersions (lifeguards: 3 vs. 1; laypersons: 5 vs. 0). Furthermore, water aspiration (lifeguards: 112 vs. 29 mL; laypersons: 160 vs. 56 mL) and physical effort (lifeguards: visual analog scale [VAS] score 7 vs. 5; laypersons: VAS score 8 vs. 6) increased significantly when IWR was performed. Lifeguards achieved significantly better ventilation characteristics and performed both rescue procedures faster and with lower side effects. IWR performed by laypersons was insufficient with regard to both tidal and minute volumes.
  
  
  CONCLUSIONS
  In-water resuscitation is associated with a delay of the rescue procedure and a relevant aspiration of water by the victim. IWR appears to be possible when performed over a short distance by well-trained professionals. The training of lifeguards must place particular emphasis on a reduction of submersions and aspiration when IWR is performed. IWR by laypersons is exhausting, time-consuming, and inefficient and should probably not be recommended. Key words: drowning; near-drowning; hypoxia; ventilation, artificial; respiration, artificial; resuscitation, in-water.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine II, Heart Center Leipzig , University of Leipzig , Germany. bernd.e.winkler@gmail.com
authors.forename: Bernd E
authors.initials: BE
authors.lastname: Winkler
authors.forename: Anna M
authors.initials: AM
authors.lastname: Eff
authors.forename: Ulrich
authors.initials: U
authors.lastname: Ehrmann
authors.forename: Sebastian
authors.initials: S
authors.lastname: Eff
authors.forename: Andreas
authors.initials: A
authors.lastname: Koch
authors.forename: Wataru
authors.initials: W
authors.lastname: Kaehler
authors.forename: Michael
authors.initials: M
authors.lastname: Georgieff
authors.forename: Claus-Martin
authors.initials: CM
authors.lastname: Muth
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D018592:Cross-Over Studies; D006801:Humans; D008348:Manikins; D015701:Near Drowning / Q000628:therapy*; D005082:Physical Exertion; D012449:Safety; D013997:Time Factors