Outcome following cardiopulmonary resuscitation in severe pediatric near-drowning
F. D. Allman, W. B. Nelson, G. A. Pacentine and G. McComb
Between April 1979 and September 1984, 66 children were admitted to the
intensive care unit (ICU) at Childrens Hospital of Los Angeles after a
severe near-drowning episode. Each patient required full cardiopulmonary
resuscitation and had an initial Glasgow coma score (GCS) of 3 in a
referring emergency room. Patients were reclassified according to results
of a neurologic examination (GCS) on arrival in the ICU. The overall
results showed 16 patients (24%) with apparently intact survival, 17
patients (26%) with vegetative survival, and 33 deaths (50%). No patient
who arrived at the ICU with a GCS of 3 (flaccid) survived neurologically
intact. Out of 37 such patients arriving in flaccid coma, 26 patients died
and 11 patients suffered severe brain damage. The majority of patients with
GCS of less than 6 underwent intracranial pressure (ICP) monitoring and
aggressive therapy directed to control ICP. Despite adequate control of ICP
and maintenance of cerebral perfusion pressure, 12 monitored patients
survived in a vegetative neurologic state. The results justify aggressive
emergency room resuscitation of severe pediatric near-drowning victims but
suggest that cerebral resuscitative measures must be subjected to critical
prospective evaluation.
