Wednesday, April 18, 2018

Review of 14 drowning publications based on the Utstein style for drowning

Title: Review of 14 drowning publications based on the Utstein style for drowning
Author: Venema A, Absalom A, Idris A, Bieren J
Journal:  Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine, March 2018

In 2003, ILCOR recommended the use of a Utstein style for drowning (USFD) approach to drowning data collection. With these recommendations came the development of a template with 22 core parameters and 19 supplemental parameters. This study aimed to "generate an inventory of the use of the USFD parameters and compare the findings of the publications that have used the USFD."

Study Design

  • Systematic review of drowning literature from 10/1/2003 to 3/22/2015
Summary of Results
  • 37 publications included from initial search
  • After exclusion for not explicitly using USFD, 8 articles remained
  • Additional search yielded 6 more articles, for a total of 14
  • None of the USFD articles included all paramters
  • 14 USFD parameters related to outcome
    • Core
      • Age
      • Date
      • Witnessed/Unwitnessed
      • Resuscitation before EMS
      • Time of first EMS Resuscitation
      • ED Vital Signs
      • ABG analysis
      • Initial neuro status
      • Airway/vent requirements
    • Supplemental
      • Approx water time
      • Time of submersion
      • Scene oxygen sat, temp, BP, pupil reaction
      • ED Pupillary reaction
      • Hospital serial neuro function
  • Non-USFD parameters associated with outcome
    • Initial cardiac rhtyhtm
    • Time points/intervals during resus
    • Intubation at scene
    • First hospital core temp
    • Serum glucose/potassium
    • Use of pressors
    • Pediatric Index of Mortality 2-score
The Bottom Line is that while the USFD is in use in peer-reviewed literature, it isn't common and there is large heterogenicity. This leads to a lack of comparatibility and to weak pooled data sets when analysis is performed to determine prognostic indicators.

A Standard Operating Procedure to Aid the Prehospital Management of Pediatric Cardiac Arrest Resulting From Submersion

TitleA Standard Operating Procedure to Aid the Prehospital Management of Pediatric Cardiac Arrest Resulting From Submersion
Authors: Best R, Harris B, Walsh J, Manfield T
Journal: Pediatric Emergency Care, May 2017

This is a simple, straight-forward article focused on developing a "Standard Operating Procedure" (SOP) for the resuscitation of a pediatric drowning patient. The authors do a stellar job of sticking with the evidence and focusing on the goal of reversing systemic hypoxemia. Included in the article is a a treatment pathway that can be easily adopted in to pre-hospital and emergency department treatment protocols.

The main points of the SOP include:

  • Utilizing a "pit-crew" approach top the resuscitation with pre-defined roles and prioritied
  • An organized approached based primarily on the respiratory status
  • Exclude unnecessary treatments like abdominal thrusts that take focus away from reversing hypoxemia
Reference


Best RR, Harris BHL, Walsh JL, Manfield T. Pediatric Drowning: A Standard
Operating Procedure to Aid the Prehospital Management of Pediatric Cardiac Arrest Resulting From Submersion. Pediatr Emerg Care. 2017 May 8.