Table 4.
Characteristics of 160 children who drowned with cardiac arrest and hypothermia at drowning scene, at arrival of emergency medical service, and at arrival at emergency department, categorised by duration of advanced life support (ALS). Number of children stated when fewer than totals. Univariate analysis odds ratio are for having good outcome
| No (%, 95% CI) or median (IQR) with ALS ≤30 minutes | No (%, 95% CI) or median (IQR) with ALS >30 minutes | OR (95% CI) | P value | |
|---|---|---|---|---|
| No of children | 62 (39, 31 to 46) | 98 (61, 54 to 69) | — | — |
| Drowning event | ||||
| Season: | ||||
| Winter | 5 (29, 8 to 51) | 12 (71, 49 to 92) | — | 0.41 |
| Other seasons | 57 (40, 32 to 48) | 86 (60, 52 to 68 ) | ||
| Median estimated submersion duration (IQR): | ||||
| Minimal (min) | 10 (5-15), n=50 | 15 (10-30), n=80 | 1.08 (1.03 to 1.23)* | <0.01 |
| Maximal (min) | 15 (10-22), n=41 | 28 (15-45), n=64 | 1.04 (1.01 to 1.07)* | <0.01 |
| Basic life support performed at scene | 52/56 (93, 86 to 100) | 72/78 (92, 86 to 98) | — | 1.0 |
| Emergency medical service | ||||
| Initial cardiac arrest rhythm: | ||||
| Asystole | 35 (35, 25 to 44) | 66 (65, 56 to 75) | — | 0.07 |
| Bradycardia | 9 (60, 35 to 85) | 6 (40, 15 to 65) | ||
| Ventricular fibrillation | 2 (100, 22 to 100) | 0 (0, 0 to 78) | — | — |
| Endotracheal intubation | 49/59 (83, 73 to 93) | 84/93 (90, 84 to 96) | — | 0.21 |
| Adrenaline | 42/54 (78, 67 to 89) | 82/85 (96, 93 to 100) | 7.81 (2.09 to 29.20) | <0.01 |
| Defibrillation | 6/51 (12, 3 to 21) | 12/69 (17, 8 to 26) | — | 0.45 |
| Emergency department | ||||
| Ongoing ALS at ED | 12 (19, 10 to 29) | 92 (94, 89 to 99) | — | — |
| Median (IQR) initial core body temperature (°C) | 30.4 (28.9-32.2) | 29.0 (27.0-31.7) | 1.16 (1.03 to 1.31)† | <0.01 |
| Initial blood gas analysis: | ||||
| Median (IQR) pH | 6.86 (6.75-6.97), n=53 | 6.58 (6.47-6.81), n=82 | 1.74 (1.41 to 2.16)‡ | <0.01 |
| Median (IQR) negative BE (mmol/L) | 26 (21-29), n=47 | 28 (25-33), n59 | 1.13 (1.05 to 1.22)§ | <0.01 |
| Median (IQR) pCO2 (kPa) | 6.1 (4.3-8.6), n=50 | 10.9 (6.2-17.0), n=76 | 1.22 (1.13 to 1.34)¶ | <0.01 |
| Median (IQR) total duration of ALS (min) | 15 (10-25) | 60 (45-90) | — | — |
| Median (IQR) total doses of adrenaline | 2 (1-3), n=45 | 6 (4-8), n=43 | 1.82 (1.41 to 2.34) | <0.01 |
| Extracorporeal life support | 0 (0, 0 to 5) | 12 (12, 6 to 19) | — | — |
| Outcome | ||||
| Death | 29 (47%, 34 to 59) | 87 (89%, 83 to 95) | 9.00 (4.04 to 20.06) | <0.01 |
| Vegetative state (PCPC 5) | 5 (8%, 1 to 15) | 5 (5%, 1 to 9) | — | 0.51 |
| Severe damage (PCPC 4) | 11 (18%, 8 to 27) | 6 (6%, 1 to 11) | 0.30 (0.11 to 0.87) | 0.03 |
| Mild-moderate damage (PCPC 2-3) | 7 (11%, 3 to 19) | 0 (0%, 0 to 3) | 0.89 (0.81 to 0.97) | <0.01 |
| No damage (PCPC 1) | 10 (16%, 7 to 25) | 0 (0%, 0 to 3) | 0.84 (0.75 to 0.94) | <0.01 |
IQR=interquartile range, ED=emergency department, BE=base excess, PCPC=paediatric cerebral performance category.
*Per 1 min increase.
†Per 1°C decrease
‡Per 0.1 decrease
§Per 1 mmol decrease.
¶Per 1 kPa increase.