Patterns of multiorgan dysfunction after pediatric drowning

Abstract

Aims: To evaluate patterns of multiorgan dysfunction and neurologic outcome in children with respiratory and cardiac arrest after drowning.

Methods: Single center retrospective chart review of children aged 0-21 years admitted between January 2001 and January 2012 to the pediatric intensive care unit at Children's Hospital of Pittsburgh with a diagnosis of drowning/submersion/immersion. Organ dysfunction scores were calculated for first 24h of admission as defined by the Pediatric Logistic Organ Dysfunction Score-1 (PELOD-1) and Pediatric Multiple Organ Dysfunction Score (P-MODS). Neurologic outcome at hospital discharge was assigned Pediatric Cerebral and Overall Performance Category Scale scores.

Results: We identified 60 cases of pediatric drowning in which 21 children experienced cardiorespiratory arrest (CA) and 39 had respiratory arrest (RA). All children with CA had multiorgan failure and 81% had a poor neurologic outcome at hospital discharge while 49% of children with RA had multiorgan failure and none had an unfavorable neurological outcome (p<0.001). The most common organ failures in both CA and RA groups within the first 24h of admission were respiratory, followed by neurologic, cardiovascular, gastrointestinal, hematological, and least commonly, renal.

Conclusion: Patterns of organ failure differ in children with CA and RA due to drowning. The contribution of multiorgan failure to poor outcome and evaluation of the impact of augmenting cerebral resuscitation with MOF-targeting therapies after drowning deserves to be explored.

Keywords: Arrest; Children; Drowning; Multiorgan failure; Neurologic outcome; Organ dysfunction.

Figure 1. Organ dysfunction by arrest group

Overall, most common organ failure within first 24 hours of PICU admission was respiratory, followed by neurologic, cardiovascular, hepatic and renal systems in both the CA and RA groups.

Figure 2. Patterns of organ dysfunction

Figures below show patterns of organ dysfunction in patients with 1, 2, 3 and > 3 organ failures as defined by PELOD-1 score > 0 for each organ. No CA patient had less than 2 organ dysfunctions and the cardiovascular system was the most common organ failure in patients with RA. CA: Cardiac arrest, RA: Respiratory arrest, PELOD: Pediatric Logistic Organ Dysfunction Score