Extracorporeal life support for victims of drowning.
Unintentional drowning is a significant public health concern in the United States and represents a leading cause of death in the pediatric population. Extracorporeal life support (ECLS) may be used to support drowning victims, but outcomes have not been well defined. This study examined survival rates and risk factors for death in this population.



Retrospective data from the Extracorporeal Life Support Organization registry was examined to determine outcomes of ECLS and risk factors for death in drowning victims.



Two hundred forty-seven patients who received ECLS following a drowning event between 1986 and 2015 were identified. Eighty-four (34%) did not experience cardiac arrest prior to ECLS, whereas 86 (35%) experienced a pre-ECLS cardiac arrest but had return of spontaneous circulation prior to ECLS, and 77 (31%) were placed on ECLS during cardiopulmonary resuscitation (ECPR). Overall survival was 51.4%; 71.4% in patients who did not experience a cardiac arrest, 57.0% in patients who required cardiopulmonary resuscitation prior to ECLS, and 23.4% in patients who received ECPR (p<0.001). Logistic regression analysis identified ECPR, venoarterial mode of ECLS, renal failure, and cardiopulmonary resuscitation during ECLS as risk factors associated with mortality.



Outcomes in drowning victims supported with ECLS are encouraging; particularly in patients who do not experience cardiac arrest. These data suggest that early initiation of ECLS in drowning patients with respiratory insufficiency may be beneficial to reduce the likelihood of complete cardiopulmonary failure and ECPR. Additionally, ECLS appears to improve survival in patients who experience post-drowning cardiac arrest.
Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, United States.
Christopher R
CR
Burke
Division of Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, United States.
Titus
T
Chan
Division of Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, United States.
Thomas V
TV
Brogan
Division of Critical Care Medicine, Stollery Children's Hospital, Edmonton, AB, United States.
Laurance
L
Lequier
Department of Cardiology, Children's Hospital, Boston, MA, United States.
Ravi R
RR
Thiagarajan
Extracorporeal Life Support Organization, Ann Arbor, MI, United States.
Peter T
PT
Rycus
Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, United States. Electronic address: michael.mcmullan@seattlechildrens.org.
D Michael
DM
McMullan
D000293:Adolescent; D000328:Adult; D016887:Cardiopulmonary Resuscitation; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004332:Drowning / Q000401:mortality*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D012042:Registries; D012131:Respiratory Insufficiency / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
Critical care; Drowning; Extracorporeal life support