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Multicenter Study
. 2021 Oct 24;25(1):372.
doi: 10.1186/s13054-021-03792-2.

Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study

Florian Reizine  1 , Agathe Delbove  2 , Alexandre Dos Santos  3 , Laetitia Bodenes  4 , Pierre Bouju  5 , Pierre Fillâtre  6 , Aurélien Frérou  7 , Guillaume Halley  8 , Olivier Lesieur  9 , Maud Jonas  10 , Florian Berteau  11 , Jean Morin  12 , David Luque-Paz  13 , Rémy Marnai  14 , Anthony Le Meur  15 , Cécile Aubron  4 , Jean Reignier  12 , Jean-Marc Tadié  13 , Arnaud Gacouin  13
Affiliations
Multicenter Study

Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study

Florian Reizine et al. Crit Care. .

Abstract

Background: Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients' prognosis remains poorly explored in Intensive Care Units (ICUs) patients.

Methods: We conducted a retrospective multicenter study on patients admitted to 14 ICUs in the west of France from January 2013 to January 2020. We first compared demographic and clinical characteristics at admission as well as clinical courses of these patients according to the salinity of drowning water. Then, we aimed to identify variables associated with 28-day survival using a Cox proportional hazard model.

Results: Of the 270 consecutive included patients, drowning occurred in seawater in 199 patients (73.7%) and in freshwater in 71 patients (26.3%). Day-28 mortality was observed in 55 patients (20.4%). Freshwater was independently associated with 28-day mortality (Adjusted Hazard Ratio (aHR) 1.84 [95% Confidence Interval (CI) 1.03-3.29], p = 0.04). A higher proportion of freshwater patients presented psychiatric comorbidities (47.9 vs. 19.1%; p < 0.0001) and the etiology of drowning appeared more frequently to be a suicide attempt in this population (25.7 vs. 4.2%; p < 0.0001). The other factors independently associated with 28-day mortality were the occurrence of a drowning-related cardiac arrest (aHR 11.5 [95% CI 2.51-52.43], p = 0.0017), duration of cardiopulmonary resuscitation (aHR 1.05 [95% CI 1.03-1.07], p < 0.0001) and SOFA score at day 1 (aHR 1.2 [95% CI 1.11-1.3], p < 0.0001).

Conclusions: In this large multicenter cohort, freshwater drowning patients had a poorer prognosis than saltwater drowning patients. Reasons for such discrepancies include differences in underlying psychiatric comorbidity, drowning circumstances and severities. Patients with initial cardiac arrest secondary to drowning remain with a very poor prognosis.

Keywords: ARDS; Cardiac arrest; Drowning; Freshwater; ICU; Saltwater.

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Conflict of interest statement

The authors report no conflict of interest related to this work.

Figures

Fig. 1
Fig. 1
Proportion of freshwater and seawater drowning patients according to the season
Fig. 2
Fig. 2
Kaplan–Meier curve reporting unadjusted influence of type of water among drowning patients
See this image and copyright information in PMC

References

    1. Szpilman D, Morgan P. Management for the Drowning Patient. Chest. 2020;159:1473. doi: 10.1016/j.chest.2020.10.007. - DOI - PubMed
    1. Bloomberg LP, World Health Organization, editors. Global report on drowning: preventing a leading killer. Geneva, Switzerland: World Health Organization; 2014.
    1. Szpilman D, Bierens JJLM, Handley AJ, Orlowski JP. Drowning. N Engl J Med. 2012;366:2102–2110. doi: 10.1056/NEJMra1013317. - DOI - PubMed
    1. Michelet P, Bouzana F, Charmensat O, Tiger F, Durand-Gasselin J, Hraiech S, et al. Acute respiratory failure after drowning: a retrospective multicenter survey. Eur J Emerg Med. 2017;24:295–300. doi: 10.1097/MEJ.0000000000000362. - DOI - PubMed
    1. Quan L, Mack CD, Schiff MA. Association of water temperature and submersion duration and drowning outcome. Resuscitation. 2014;85:790–794. doi: 10.1016/j.resuscitation.2014.02.024. - DOI - PubMed

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