What is the emergency treatment for a drowning victim?

From the Guidelines

The emergency treatment for a drowning victim begins with removing them from the water and immediately checking for responsiveness and breathing, as emphasized by the 2024 American Heart Association and American Academy of Pediatrics guidelines 1. If the victim is unresponsive and not breathing normally, call emergency services (911) and begin CPR immediately. Start with 30 chest compressions followed by 2 rescue breaths, continuing this cycle until help arrives. For chest compressions, place the heel of your hand on the center of the chest and compress at least 2 inches deep at a rate of 100-120 compressions per minute, as recommended by the American Heart Association guidelines 1. If you're not trained in CPR, perform hands-only CPR (chest compressions without rescue breaths). Once the victim is breathing, place them in the recovery position (on their side with the head tilted back) to prevent aspiration if they vomit. Remove wet clothing and keep the victim warm with dry blankets to prevent hypothermia. Do not attempt to drain water from the lungs by turning the victim upside down or on their side, as this is ineffective and wastes critical time, according to the 2010 American Heart Association guidelines 1. All drowning victims should be evaluated by medical professionals even if they seem to have recovered, as complications like secondary drowning can occur hours later due to lung inflammation and fluid buildup. Key considerations in the emergency treatment of drowning victims include:

• Recognizing distress and calling for help promptly, as highlighted in the 2024 American Heart Association and American Academy of Pediatrics focused update 1
• Providing flotation to the drowned person to prevent submersion, as recommended by the 2024 American Heart Association and American Academy of Pediatrics guidelines 1
• Initiating CPR as soon as possible, with a focus on early BLS contributing to a good outcome, as emphasized by the 2024 American Heart Association and American Academy of Pediatrics guidelines 1

From the Research

Emergency Treatment for Drowning Victims

The emergency treatment for a drowning victim involves several key steps to address the primary physiologic insult of hypoxia and associated clinical concerns.

• Immediate interruption of hypoxia is crucial, and aggressive treatment of hypothermia and cardiovascular failure are cornerstones of correct medical treatment 2.
• The primary focus should be on the key components of pathophysiology that require immediate attention, including hypoxia, hypothermia, and mechanical ventilation 3.
• Ventilation therapy should aim to achieve an intrapulmonary shunt ≤ 20% or Pao2:Fio2 ≥ 250, and premature ventilatory weaning should be avoided to prevent the return of pulmonary edema 4.

Resuscitation and Treatment

• Cardiopulmonary resuscitation (CPR) is critical in the treatment of drowning victims, and the use of extracorporeal membrane oxygenation (ECMO) systems may be considered in severe cases of accidental hypothermia after drowning 5.
• The combination of epinephrine and vasopressin may be effective in cardiopulmonary resuscitation attempts, as demonstrated in a case report of a near-drowned child 6.
• Aggressive initial therapeutic efforts are indicated in most near-drowning victims, as accurate neurologic prognosis cannot be predicted from initial clinical presentation, laboratory, radiological, or electrophysiological examinations 2.

Hospitalization and Disposition

• The decision to admit to an intensive care unit (ICU) should consider the patient's drowning severity and comorbid or premorbid conditions 4.
• Safe and reasonable disposition plans should be formed based on the management of associated clinical concerns, such as hypothermia, mechanical ventilation, and traumatic injuries 3.