title: Patterns of multiorgan dysfunction after pediatric drowning.
abstract: OBJECTIVE
  To evaluate patterns of multiorgan dysfunction and neurologic outcome in children with respiratory and cardiac arrest after drowning.
  
  
  METHODS
  Single center retrospective chart review of children aged 0-21 years admitted between January 2001 and January 2012 to the pediatric intensive care unit at Children's Hospital of Pittsburgh with a diagnosis of drowning/submersion/immersion. Organ dysfunction scores were calculated for first 24h of admission as defined by the Pediatric Logistic Organ Dysfunction Score-1 (PELOD-1) and Pediatric Multiple Organ Dysfunction Score (P-MODS). Neurologic outcome at hospital discharge was assigned Pediatric Cerebral and Overall Performance Category Scale scores.
  
  
  RESULTS
  We identified 60 cases of pediatric drowning in which 21 children experienced cardiorespiratory arrest (CA) and 39 had respiratory arrest (RA). All children with CA had multiorgan failure and 81% had a poor neurologic outcome at hospital discharge while 49% of children with RA had multiorgan failure and none had an unfavorable neurological outcome (p<0.001). The most common organ failures in both CA and RA groups within the first 24h of admission were respiratory, followed by neurologic, cardiovascular, gastrointestinal, hematological, and least commonly, renal.
  
  
  CONCLUSIONS
  Patterns of organ failure differ in children with CA and RA due to drowning. The contribution of multiorgan failure to poor outcome and evaluation of the impact of augmenting cerebral resuscitation with MOF-targeting therapies after drowning deserves to be explored.
authors.affiliation: Critical Care Department, The Hospital for Sick Children, Toronto, Canada; Safar Center for Resuscitation Research, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States.
authors.forename: Haifa
authors.initials: H
authors.lastname: Mtaweh
authors.affiliation: Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kochanek
authors.affiliation: Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Carcillo
authors.affiliation: Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States; Department of Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
authors.affiliation: Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States. Electronic address: finkel@ccm.upmc.edu.
authors.forename: Ericka L
authors.initials: EL
authors.lastname: Fink
mesh_terms: D000293:Adolescent; D001049:Apnea / Q000209:etiology*; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D004332:Drowning; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology* / Q000401:mortality; D063305:Organ Dysfunction Scores; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Arrest; Children; Drowning; Multiorgan failure; Neurologic outcome; Organ dysfunction