Neurocritical Care

, Volume 17, Issue 3, pp 441–467 | Cite as

Brain Resuscitation in the Drowning Victim

  • Alexis A. Topjian
  • Robert A. Berg
  • Joost J. L. M. Bierens
  • Christine M. Branche
  • Robert S. Clark
  • Hans Friberg
  • Cornelia W. E. Hoedemaekers
  • Michael Holzer
  • Laurence M. Katz
  • Johannes T. A. Knape
  • Patrick M. Kochanek
  • Vinay Nadkarni
  • Johannes G. van der Hoeven
  • David S. Warner
Review Article
First Online:

Abstract

Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32–34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders.

Keywords

Drowning Brain Asphyxia Cardiac arrest 
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Notes

Acknowledgments

The authors are grateful to the Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning), Amsterdam, the Netherlands, which supported costs and organization of the consensus conference associated with this work.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Alexis A. Topjian
    • 1
  • Robert A. Berg
    • 1
  • Joost J. L. M. Bierens
    • 2
  • Christine M. Branche
    • 3
  • Robert S. Clark
    • 4
  • Hans Friberg
    • 5
    • 6
  • Cornelia W. E. Hoedemaekers
    • 7
  • Michael Holzer
    • 8
  • Laurence M. Katz
    • 9
  • Johannes T. A. Knape
    • 10
  • Patrick M. Kochanek
    • 11
  • Vinay Nadkarni
    • 1
  • Johannes G. van der Hoeven
    • 7
  • David S. Warner
    • 12
  1. 1.The Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Maatschappij tot Redding van DrenkelingenAmsterdamThe Netherlands
  3. 3.National Institute for Occupational Safety and Health/Centers for Disease ControlWashingtonUSA
  4. 4.Children’s Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghUSA
  5. 5.Department of Intensive and Perioperative CareSkåne University HospitalLundSweden
  6. 6.Department of Clinical SciencesLund UniversityLundSweden
  7. 7.Department of ICURadboud University Nijmegen Medical CenterNijmegenThe Netherlands
  8. 8.Department of Emergency MedicineMedical University of ViennaViennaAustria
  9. 9.Department of Emergency Medicine, NeurosciencesUniversity of North Carolina at Chapel HillChapel HillUSA
  10. 10.Afdeling AnesthesiologieUniversity Medical Center UtrechtUtrechtThe Netherlands
  11. 11.Department of Critical Care Medicine, Safar Center for Resuscitation ResearchUniversity of Pittsburgh School of MedicinePittsburghUSA
  12. 12.Department of AnesthesiologyDuke University Medical CenterDurhamUSA

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