A systematic review of interventions for resuscitation following drowning

Joost Bierens; Janet Bray; Cristian Abelairas-Gomez; Roberto Barcala-Furelos; Stephen Beerman; Andreas Claesson; Cody Dunne; Tatsuma Fukuda; Muralidharan Jayashree; Anthony T Lagina; Lei Li; Tom Mecrow; Patrick Morgan; Andrew Schmidt; Jeroen Seesink; Justin Sempsrott; David Szpilman; Ogilvie Thom; Joshua Tobin; Jonathon Webber; Samantha Johnson; Gavin D Perkins; International Liaison Committee on Resuscitation BLS/AED Task Force

doi:10.1016/j.resplu.2023.100406

A systematic review of interventions for resuscitation following drowning

Resusc Plus. 2023 Jun 8:14:100406. doi: 10.1016/j.resplu.2023.100406. eCollection 2023 Jun.

Authors

Joost Bierens¹, Janet Bray², Cristian Abelairas-Gomez³, Roberto Barcala-Furelos⁴, Stephen Beerman⁵, Andreas Claesson⁶, Cody Dunne⁷, Tatsuma Fukuda⁸, Muralidharan Jayashree⁹, Anthony T Lagina¹⁰, Lei Li^{10

11}, Tom Mecrow¹², Patrick Morgan¹, Andrew Schmidt¹³, Jeroen Seesink¹⁴, Justin Sempsrott¹⁵, David Szpilman¹⁶, Ogilvie Thom¹⁷, Joshua Tobin¹⁸, Jonathon Webber¹⁹, Samantha Johnson²⁰, Gavin D Perkins²⁰; International Liaison Committee on Resuscitation BLS/AED Task Force

Affiliations

¹ Extreme Environments Laboratory, University of Portsmouth, Portsmouth, UK.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
³ CLINURSID Research Group and Faculty of Education Sciences, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
⁴ REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo. Pontevedra, Spain.
⁵ Faculty of Medicine, University of British Columbia, Canada.
⁶ Centre for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
⁷ Department of Emergency Medicine, University of Calgary, Canada.
⁸ Department of Emergency and Critical Care Medicine, Toranomon Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan.
⁹ Department of Pediatrics. Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
¹⁰ School of Emergency Medicine, Wayne State University, Detroit, USA.
¹¹ Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹² Royal National Lifeboat Institution, West Quay Road, Poole, Dorset, UK.
¹³ Department of Emergency Medicine, University of Florida-Jacksonville, Jacksonville, USA.
¹⁴ Erasmus MC University Medical Center, Department of Anaesthesiology, Rotterdam, the Netherlands.
¹⁵ Lifeguards Without Borders, Kuna, ID, USA.
¹⁶ Brazilian Lifesaving Society, SOBRASA, Rio de Janeiro, Brazil.
¹⁷ College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia.
¹⁸ UT Health San Antonio, Dept of Anesthesiology, San Antonio, USA.
¹⁹ Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand.
²⁰ Warwick Medical School, University of Warwick, Coventry, UK.

Abstract

Objectives: The International Liaison Committee on Resuscitation, in collaboration with drowning researchers from around the world, aimed to review the evidence addressing seven key resuscitation interventions: 1) immediate versus delayed resuscitation; (2) compression first versus ventilation first strategy; (3) compression-only CPR versus standard CPR (compressions and ventilations); (4) ventilation with and without equipment; (5) oxygen administration prior to hospital arrival; (6) automated external defibrillation first versus cardiopulmonary resuscitation first strategy; (7) public access defibrillation programmes.

Methods: The review included studies relating to adults and children who had sustained a cardiac arrest following drowning with control groups and reported patient outcomes. Searches were run from database inception through to April 2023. The following databases were searched Ovid MEDLINE, Pre-Medline, Embase, Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the ROBINS-I tool and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. The findings are reported as a narrative synthesis.

Results: Three studies were included for two of the seven interventions (2,451 patients). No randomised controlled trials were identified. A retrospective observational study reported in-water resuscitation with rescue breaths improved patient outcomes compared to delayed resuscitation on land (n = 46 patients, very low certainty of evidence). The two observational studies (n = 2,405 patients), comparing compression-only with standard resuscitation, reported no difference for most outcomes. A statistically higher rate of survival to hospital discharge was reported for the standard resuscitation group in one of these studies (29.7% versus 18.1%, adjusted odds ratio 1.54 (95% confidence interval 1.01-2.36) (very low certainty of evidence).

Conclusion: The key finding of this systematic review is the paucity of evidence, with control groups, to inform treatment guidelines for resuscitation in drowning.

Keywords: Cardiac Arrest; Drowning; International Liaison Committee on Resuscitation; Resuscitation.

Publication types

Review