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

A systematic review of interventions for resuscitation following drowning

Joost Bierens  1 , Janet Bray  2 , Cristian Abelairas-Gomez  3 , Roberto Barcala-Furelos  4 , Stephen Beerman  5 , Andreas Claesson  6 , Cody Dunne  7 , Tatsuma Fukuda  8 , Muralidharan Jayashree  9 , Anthony T Lagina  10 , Lei Li  10   11 , Tom Mecrow  12 , Patrick Morgan  1 , Andrew Schmidt  13 , Jeroen Seesink  14 , Justin Sempsrott  15 , David Szpilman  16 , Ogilvie Thom  17 , Joshua Tobin  18 , Jonathon Webber  19 , Samantha Johnson  20 , Gavin D Perkins  20 ; International Liaison Committee on Resuscitation BLS/AED Task Force
Affiliations
Review

A systematic review of interventions for resuscitation following drowning

Joost Bierens et al. Resusc Plus. .

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.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This systematic review was part of the ILCOR continuous evidence evaluation process, which is guided by a rigorous conflict of interest policy (see www.ilcor.org). GDP declares roles as co-chair of ILCOR, Director of Science and Research for the European Resuscitation Council, Vice President of the Resuscitation Council UK and Editor roles with Resuscitation and Resuscitation Plus journals. He is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. JB declares her role as an Associate Editor for Resuscitation Plus. The paper was handled by Associate Editor Keith Couper.

References

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    1. Idris A.H., Bierens J., Perkins G.D., et al. 2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement. Resuscitation. 2017;118:147–158. - PubMed

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