A systematic review of interventions for resuscitation following drowning.
Joost Bierens, Janet Bray, Cristian Abelairas-Gomez, Roberto Barcala-Furelos, Stephen Beerman, Andreas Claesson, Cody Dunne, Tatsuma Fukuda, Muralidharan Jayashree, Anthony T Lagina, Lei Li, Tom Mecrow, Patrick Morgan, Andrew Schmidt, Jeroen Seesink, Justin Sempsrott, David Szpilman, Ogilvie Thom, Joshua Tobin, Jonathon Webber, Samantha Johnson, Gavin D Perkins, International Liaison Committee on Resuscitation BLS/AED Task Force
Author Information
Joost Bierens: Extreme Environments Laboratory, University of Portsmouth, Portsmouth, UK.
Janet Bray: School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Cristian Abelairas-Gomez: CLINURSID Research Group and Faculty of Education Sciences, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
Roberto Barcala-Furelos: REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo. Pontevedra, Spain.
Stephen Beerman: Faculty of Medicine, University of British Columbia, Canada.
Andreas Claesson: Centre for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Cody Dunne: Department of Emergency Medicine, University of Calgary, Canada.
Tatsuma Fukuda: Department of Emergency and Critical Care Medicine, Toranomon Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan.
Muralidharan Jayashree: Department of Pediatrics. Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Anthony T Lagina: School of Emergency Medicine, Wayne State University, Detroit, USA.
Lei Li: School of Emergency Medicine, Wayne State University, Detroit, USA.
Tom Mecrow: Royal National Lifeboat Institution, West Quay Road, Poole, Dorset, UK.
Patrick Morgan: Extreme Environments Laboratory, University of Portsmouth, Portsmouth, UK.
Andrew Schmidt: Department of Emergency Medicine, University of Florida-Jacksonville, Jacksonville, USA.
Jeroen Seesink: Erasmus MC University Medical Center, Department of Anaesthesiology, Rotterdam, the Netherlands.
Justin Sempsrott: Lifeguards Without Borders, Kuna, ID, USA.
David Szpilman: Brazilian Lifesaving Society, SOBRASA, Rio de Janeiro, Brazil.
Ogilvie Thom: College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia.
Joshua Tobin: UT Health San Antonio, Dept of Anesthesiology, San Antonio, USA.
Jonathon Webber: Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand.
Samantha Johnson: Warwick Medical School, University of Warwick, Coventry, UK.
Gavin D Perkins: Warwick Medical School, University of Warwick, Coventry, UK.
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 ( = 46 patients, very low certainty of evidence). The two observational studies ( = 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.
