Monday, May 9, 2016

Extracorporeal life support for victims of drowning

Title: Extracorporeal life support for victims of drowning
Authors: Burke CR, et al
Journal: Resuscitation, April 10, 2016 [epub ahead of publication]

This article analyses a subset of patients from the Extracorporeal Life Support (ELSO) international registry, which collects data from patients undergoing extracorporeal life support (ECLS) from over 400 international centers. Data for drowning patients from 1986 to 2015 were queried from the registry.

Primary outcome: survival to hospital discharge or transfer
Patients: 247 total (49 adults, 198 pediatrics)

  • 35% had cardiac arrest with ROSC prior to ECLS (Arrest group)
  • 31% ad ECLS initiated during cardiac arrest (ECPR group)
  • 34% did not have cardiac arrest before or during ECLS (No Arrest group)
  • Overall survival 51%
    • No Arrest: 74%
    • Arrest: 57%
    • ECPR: 23%
  • Younger patients more likely to be "No Arrest"
  • Non-survivors
    • more likely to be "Arrest" than survivors
    • No difference in age, sex, race
    • Presented with lower pH, lower SaO2, and more hypothermia

Unfortunately, this article does not answer any of the big questions in drowning resuscitation, primarily "who is walking out of the hospital with good neurologic outcome".  The authors acknowledge this weakness, but it is somewhat beyond their control as the registry itself is limited and primarily focused on ECLS itself and not specific diseases/injuries leading to ECLS.  I do like the use of an international registry to gather a wide-array of data across multiple institutions, but what is needed next is a method to match this data with more robust pre-hospital and hospital data and, most importantly, neurologic outcome data.  To data, the question as to whether ECLS is beneficial in drowning patients has yet to be answered, but registries like this may make it possible one day.  The conclusions gained from this article are in line with previous evidence: Those who experience cardiac arrest do worse, pediatrics tend to do better, and those who are severely acidotic, hypoxic, or hypothermic on arrival do worse.