title: Extracorporeal life support (ECLS) for refractory cardiac arrest after drowning: an 11-year experience.
abstract: OBJECTIVE
  Neuroprotective effects of hypothermia may explain surprisingly high survival rates reported after drowning in cold water despite prolonged submersion. We described a cohort of refractory hypothermic cardiac arrests (CA) due to drowning treated by extracorporeal life support (ECLS) and aimed to identify criteria associated with 24-h survival.
  
  
  METHODS
  Eleven-year period (2002-2012) retrospective study in the surgical intensive care unit (ICU) of a tertiary hospital (European Hospital Georges Pompidou, Paris, France). All consecutive hypothermic patients admitted for refractory CA after drowning in the Seine River were included. Patients with core temperature below 30°C and submersion duration of less than 1h were potentially eligible for ECLS resuscitation.
  
  
  RESULTS
  Forty-three patients were admitted directly to the ICU during the study period. ECLS was initiated in 20 patients (47%). Among these 20 patients, only four (9%) survived more than 24h. A first hospital core temperature ≤26°C and a potassium serum level between 4.2 and 6mM at hospital admission have a sensitivity of 100% [95%CI: 28-100%] and a specificity of 100% [95%CI: 71-100%] to discriminate patients who survived more than 24h. Overall survival at ICU discharge and at 6-months was 5% [95%CI: 1-16%] (two patients).
  
  
  CONCLUSIONS
  Despite patient hypothermia and aggressive resuscitation with ECLS, the observed survival rate is low in the present cohort. Like existing algorithms for ECLS management in avalanche victims, we recommend to use first core temperature and potassium serum level to indicate ECLS for refractory CA due to drowning.
authors.affiliation: Surgical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France. Electronic address: b.champigneulle@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Champigneulle
authors.affiliation: Surgical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Bellenfant-Zegdi
authors.affiliation: Surgical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Follin
authors.affiliation: Surgical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Lebard
authors.affiliation: Surgical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Guinvarch
authors.affiliation: Surgical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Thomas
authors.affiliation: Surgical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France; Department of Biostatistics and Medical Informatics, INSERM U-1153, ECSTRA team, Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Pirracchio
authors.affiliation: Surgical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Journois
mesh_terms: D000328:Adult; D022561:Advanced Cardiac Life Support / Q000379:methods*; D005260:Female; D005544:Forecasting; D005602:France / Q000453:epidemiology; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D015701:Near Drowning / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: Cardiac arrest; Drowning; Extracorporeal rewarming; Hypothermia