Can we identify termination of resuscitation criteria in cardiac arrest due to drowning: results from the French national out-of-hospital cardiac arrest registry.
OBJECTIVE
The aim of this study was to describe the cohort of persons having experiences fatal and non-fatal drowning events, registered in the French cardiac arrest registry and to identify termination of resuscitation criteria.


METHODS
We performed a prospective multicenter study based on data from French cardiac arrest registry database. All patients with cardiac arrest after drowning (CAD) recorded between July 2011 and November 2014 were included. The population description was carried out by medians [interquartile ranges (IQR)] or frequencies. The characteristics were compared in terms of the primary endpoint (alive vs dead at hospital admission) using chi-square or Fisher's exact and the Mann-Whitney U test. The predictive model was carried out using the multivariate logistic regression.


RESULTS
The analysis included 234 CAD. The majority of patients were adults (83.6%) and males (64.5%). Most of the submersions occurred out of home (75.6%). We recorded 66.7% of incidents in fresh water. About a third of CAD was witnessed of which 33.8% had an immediate basic life support. Most of CAD patients received an advanced cardiac life support (87.2%). The median Mobile Medical Team response time was 22 [15-30] minutes. At hospital, 40.6% of patients were alive. Twenty one patients (9.0%) were discharged alive. Among them, 17 had a good neurological outcome. Faster interventions generally resulted in higher survival chances (Mobile Medical Team response time OR: 0.960[0.925; 0.996]; P = 0.0.031; no flow duration OR: 0.535[0.313; 0.913]; P = 0.022) if associated with ventilation (OR: 6.742[2.043; 22.250]; P = 0.002). Age (OR: 0.971[0.955; 0.988]; P = 0.001) and location outside (OR: 0.203[0.064; 0.625]; P = 0.007) are the other criteria of our model.


CONCLUSIONS
The model is helpful to highlight explanative variables concerning CAD patients' outcome. The next step is the validation of these five factors by a larger study. Prevention and public training to lifesaving behaviours must be considered as priorities in French public health programmes.
Public Health Department EA 2694, ILIS-University of Lille, Loos, France.
Hervé
H
Hubert
Public Health Department EA 2694, ILIS-University of Lille, Loos, France.
Joséphine
J
Escutnaire
Department of Emergency Medicine, AP-HM, Marseille, France.
Pierre
P
Michelet
Public Health Department EA 2694, ILIS-University of Lille, Loos, France.
Evgéniya
E
Babykina
RESCUE (Réseau Cardiologie Médecine d'Urgence) Network, Hussel Hospital, Vienne, France.
Carlos
C
El Khoury
SAMU 69 and the department of Emergency Medicine, Lyon University Hospital, University of Claude Bernard-Lyon 1, Lyon, France.
Karim
K
Tazarourte
Public Health Department EA 2694, ILIS-University of Lille, Loos, France.
Christian
C
Vilhelm
Risk Research Centre, University of Mons, Mons, Belgium.
Lahcen
L
El Hiki
Public Health Department EA 2694, ILIS-University of Lille, Loos, France.
Benjamin
B
Guinhouya
SAMU 69 and the department of Emergency Medicine, Lyon University Hospital, University of Claude Bernard-Lyon 1, Lyon, France.
Pierre-Yves
PY
Gueugniaud
Research Group on the French National Out-of-hospital Cardiac Arrest Registry, RéAC, Lille, France.
D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D016208:Databases, Factual; D004332:Drowning; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest; D012042:Registries; D028761:Withholding Treatment; D055815:Young Adult
RéAC; cardiac arrest; drowning; out-of-hospital; prognostic criteria; registry